Provider Demographics
NPI:1932519618
Name:ALLAN, TERRY (PHARMD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:ALLAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CLAY STREET
Mailing Address - Street 2:
Mailing Address - City:GILLESPIE
Mailing Address - State:IL
Mailing Address - Zip Code:62033
Mailing Address - Country:US
Mailing Address - Phone:217-556-5727
Mailing Address - Fax:
Practice Address - Street 1:113 SOUTH MACOUPIN STREET
Practice Address - Street 2:
Practice Address - City:GILLESPIE
Practice Address - State:IL
Practice Address - Zip Code:62033
Practice Address - Country:US
Practice Address - Phone:217-839-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist