Provider Demographics
NPI:1427680438
Name:TERRY, ERNEST (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:
Last Name:TERRY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:ERNEST
Other - Middle Name:
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6300 EASTOVER DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-3622
Mailing Address - Country:US
Mailing Address - Phone:504-473-3855
Mailing Address - Fax:985-280-8678
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-280-8962
Practice Address - Fax:985-280-8678
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13567Medicaid