Provider Demographics
NPI:1356622823
Name:TERRELL, SCOTT E (DPH)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:E
Last Name:TERRELL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5852
Mailing Address - Country:US
Mailing Address - Phone:405-440-0342
Mailing Address - Fax:405-440-2891
Practice Address - Street 1:2316 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-5852
Practice Address - Country:US
Practice Address - Phone:405-440-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist