Provider Demographics
NPI:1063034700
Name:PERA, TERRI LYN (RPH)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LYN
Last Name:PERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LYN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12503 E EUCLID DR STE 80
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6400
Mailing Address - Country:US
Mailing Address - Phone:303-708-1124
Mailing Address - Fax:
Practice Address - Street 1:12503 E EUCLID DR STE 80
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-6400
Practice Address - Country:US
Practice Address - Phone:303-708-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA0014827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist