Provider Demographics
NPI:1053940668
Name:GREENQUIST, TERRENCE ALAN (RPH)
Entity type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:ALAN
Last Name:GREENQUIST
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 1:205 80TH ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1930
Mailing Address - Country:US
Mailing Address - Phone:757-871-3933
Mailing Address - Fax:
Practice Address - Street 1:205 80TH ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1930
Practice Address - Country:US
Practice Address - Phone:757-871-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist