Provider Demographics
NPI:1811264492
Name:TERRELL MONTGOMERY, DENEEN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:DENEEN
Middle Name:
Last Name:TERRELL MONTGOMERY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:DENEEN
Other - Middle Name:
Other - Last Name:KENNEDY TERRELL-MONTGOMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2220 FOXTROT RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5046
Mailing Address - Country:US
Mailing Address - Phone:919-821-5066
Mailing Address - Fax:
Practice Address - Street 1:2220 FOXTROT RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5046
Practice Address - Country:US
Practice Address - Phone:919-821-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC097581835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09758OtherNC BOARD OF PHARMACY