Provider Demographics
NPI:1366736738
Name:TERRY, MEECHELLE LYN (PHARMD)
Entity type:Individual
Prefix:
First Name:MEECHELLE
Middle Name:LYN
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 DUNLAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4757
Mailing Address - Country:US
Mailing Address - Phone:386-767-6082
Mailing Address - Fax:386-767-6082
Practice Address - Street 1:1771 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4757
Practice Address - Country:US
Practice Address - Phone:386-767-6082
Practice Address - Fax:386-767-6082
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 37962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist