Provider Demographics
NPI:1720680895
Name:SPEARS, TERRY (RPH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:SPEARS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1737
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76385-1737
Mailing Address - Country:US
Mailing Address - Phone:940-552-2999
Mailing Address - Fax:940-552-5347
Practice Address - Street 1:1720 HILLCREST DR STE A
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4099
Practice Address - Country:US
Practice Address - Phone:940-552-2999
Practice Address - Fax:940-552-5347
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist