Provider Demographics
NPI:1053381814
Name:WILLS, TERRY FENTON (PHARM D)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:FENTON
Last Name:WILLS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 CATHEDRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2905
Mailing Address - Country:US
Mailing Address - Phone:301-791-1764
Mailing Address - Fax:
Practice Address - Street 1:251 E ANTIETAM ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5724
Practice Address - Country:US
Practice Address - Phone:301-790-8643
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist