Provider Demographics
NPI:1306055157
Name:ADDISON, TERRY LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LYNN
Last Name:ADDISON
Suffix:
Gender:F
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:FORT SUMNER
Mailing Address - State:NM
Mailing Address - Zip Code:88119-0550
Mailing Address - Country:US
Mailing Address - Phone:505-355-7357
Mailing Address - Fax:505-355-7816
Practice Address - Street 1:127 E. SUMNER AVE.
Practice Address - Street 2:
Practice Address - City:FORT SUMNER
Practice Address - State:NM
Practice Address - Zip Code:88119-0550
Practice Address - Country:US
Practice Address - Phone:505-355-7357
Practice Address - Fax:505-355-7816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00003929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist