Provider Demographics
NPI:1588339980
Name:BIRD, TERRA CHARLOTTE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TERRA
Middle Name:CHARLOTTE
Last Name:BIRD
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TYLER
Other - Middle Name:CHARLES
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:201 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2996
Mailing Address - Country:US
Mailing Address - Phone:845-331-2070
Mailing Address - Fax:845-331-0012
Practice Address - Street 1:201 PLAZA RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2996
Practice Address - Country:US
Practice Address - Phone:845-331-2070
Practice Address - Fax:845-331-0012
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist