Provider Demographics
NPI:1053537258
Name:FULL, TERENCE MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:MICHAEL
Last Name:FULL
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 1:825 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4866
Mailing Address - Country:US
Mailing Address - Phone:507-454-4925
Mailing Address - Fax:
Practice Address - Street 1:825 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4866
Practice Address - Country:US
Practice Address - Phone:507-454-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist