Provider Demographics
NPI:1548886336
Name:TERRY, CHELSEA RAY (PHARMD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RAY
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 1:658 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1106
Mailing Address - Country:US
Mailing Address - Phone:734-780-1482
Mailing Address - Fax:
Practice Address - Street 1:100 CABELAS BLVD E
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-9693
Practice Address - Country:US
Practice Address - Phone:734-529-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54655183500000X
MI5302041025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist