Provider Demographics
NPI:1730232299
Name:TERRELL, THOMAS III (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:TERRELL
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8023 W ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:IL
Mailing Address - Zip Code:61528-9643
Mailing Address - Country:US
Mailing Address - Phone:309-243-1880
Mailing Address - Fax:309-655-3072
Practice Address - Street 1:8023 W ROBERTSON RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:IL
Practice Address - Zip Code:61528-9643
Practice Address - Country:US
Practice Address - Phone:309-243-1880
Practice Address - Fax:309-655-3072
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist