Provider Demographics
NPI:1588947667
Name:TERRY, KRISTIN H (RPH)
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:H
Last Name:TERRY
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 1:1649 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3017
Mailing Address - Country:US
Mailing Address - Phone:773-281-8439
Mailing Address - Fax:773-281-8480
Practice Address - Street 1:1649 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3017
Practice Address - Country:US
Practice Address - Phone:773-281-8439
Practice Address - Fax:773-281-8480
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1992711477Other1992711477 STORE NPI