Provider Demographics
NPI:1356941736
Name:MCALLISTER, TERRIANN
Entity type:Individual
Prefix:
First Name:TERRIANN
Middle Name:
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRIANN
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-3433
Mailing Address - Country:US
Mailing Address - Phone:570-840-7773
Mailing Address - Fax:
Practice Address - Street 1:3271 ROUTE 940
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1150
Practice Address - Country:US
Practice Address - Phone:570-895-4781
Practice Address - Fax:570-895-4787
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP04381L333600000X
PARP04831L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy