Provider Demographics
NPI:1952617458
Name:WHEELER, TERRANCE WILLIAM (RPH, RRT)
Entity type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:WILLIAM
Last Name:WHEELER
Suffix:
Gender:M
Credentials:RPH, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38241 PROCTOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8019
Mailing Address - Country:US
Mailing Address - Phone:503-668-1384
Mailing Address - Fax:503-826-1209
Practice Address - Street 1:38241 PROCTOR BLVD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8019
Practice Address - Country:US
Practice Address - Phone:503-668-1384
Practice Address - Fax:503-826-1209
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist