Provider Demographics
NPI:1063729549
Name:SACK, TERRY JOSEPH
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:JOSEPH
Last Name:SACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 ESPY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2117
Mailing Address - Country:US
Mailing Address - Phone:412-561-4236
Mailing Address - Fax:
Practice Address - Street 1:2731 ESPY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2117
Practice Address - Country:US
Practice Address - Phone:412-561-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP026556L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist