Terrell Lane Boler
Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Brandon, MS
NPI 1366082893 · NPPES record last updated Mar 13, 2020
Key facts
- NPI
- 1366082893
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
- License
- E-010540 (MS)
- Practice address
- 1811 W Government St
Brandon, MS 39042-2414 - Phone
- (601) 825-3773
- Fax
- (601) 591-4408
- NPI assigned
- Jan 13, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-010540 | MS | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | E-010540 | MS | Yes |
Addresses
Primary practice location
1811 W Government St
Brandon, MS 39042-2414
Mailing address
1811 W Government St
Brandon, MS 39042-2414
Phone (601) 825-3773
Other providers in Brandon, MS
- Blair McGee OT, LLC
- Noralyn Christina Blalock-Perkins
- Jasmine Arlean Blanks
- Bleigh Incorporated
- Kiessha Body
- Sandra J Bonom
- Ritha G Bookert
- Melissa Bordelon Shields
- Merikelly Borgognoni
- Lyinka Nicole Boston
All providers in Brandon, MS · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.