Provider Demographics
NPI:1912926072
Name:MAHAN, TERRY D (RPH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:MAHAN
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 1:12358 E KALIL DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3305
Mailing Address - Country:US
Mailing Address - Phone:480-614-9049
Mailing Address - Fax:480-767-9776
Practice Address - Street 1:12358 E KALIL DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-3305
Practice Address - Country:US
Practice Address - Phone:480-614-9049
Practice Address - Fax:480-767-9776
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist