1225175102 NPI number — MRS. TERRI D DOSS RPH

Table of content: MRS. TERRI D DOSS RPH (NPI 1225175102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225175102 NPI number — MRS. TERRI D DOSS RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOSS
Provider First Name:
TERRI
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225175102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALLORY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25634-0321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-583-9980
Provider Business Mailing Address Fax Number:
304-583-7902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E MCDONALD AVE
Provider Second Line Business Practice Location Address:
PRESCRIPTION CENTER
Provider Business Practice Location Address City Name:
MAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25635-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-583-7900
Provider Business Practice Location Address Fax Number:
304-583-7902
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP0005317 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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