Provider Demographics
NPI:1730585696
Name:YODER, TERRENCE DALE (RPH)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:DALE
Last Name:YODER
Suffix:
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 1:54366 PALESTINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:QUAKER CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43773-9004
Mailing Address - Country:US
Mailing Address - Phone:740-679-2552
Mailing Address - Fax:
Practice Address - Street 1:54366 PALESTINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:QUAKER CITY
Practice Address - State:OH
Practice Address - Zip Code:43773-9004
Practice Address - Country:US
Practice Address - Phone:740-679-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03324179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist