Provider Demographics
NPI:1912503871
Name:DE LA ROSA, TERRI L (RPH)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:DE LA ROSA
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 1:301 E MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3366
Mailing Address - Country:US
Mailing Address - Phone:956-698-6121
Mailing Address - Fax:956-698-6131
Practice Address - Street 1:301 E MORRISON RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3366
Practice Address - Country:US
Practice Address - Phone:956-698-6121
Practice Address - Fax:856-698-6131
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist