Provider Demographics
NPI:1780157784
Name:BULLARD, TERRI L (PHARMD)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:BULLARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 COUNTY ROAD 4797
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023-5632
Mailing Address - Country:US
Mailing Address - Phone:801-230-4375
Mailing Address - Fax:
Practice Address - Street 1:417 W ROCK ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BOYD
Practice Address - State:TX
Practice Address - Zip Code:76023-3103
Practice Address - Country:US
Practice Address - Phone:940-433-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4746132-1701183500000X
TX61547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty