# ROBIN GODFREY TERRERO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WELLNESS STORE COMPOUNDING PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518941392
- **Authorized official:** ROBIN TERRERO RPH (PIC)
- **Authorized official phone:** (423) 476-4312

## Contact information

- **Practice address:** 3555 KEITH ST NW STE 210, CLEVELAND, TN 37312-4375
- **Practice address phone:** (423) 476-4312
- **Practice address fax:** (423) 476-7982
- **Mailing address:** 3555 KEITH ST NW STE 210, CLEVELAND, TN 37312-4375
- **Mailing address phone:** (423) 476-4312
- **Mailing address fax:** (423) 476-7982

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 3223 | TN | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 12/05/2005
- **Last updated:** 04/03/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1452909 | — | TN |
| 01 | — | 2092295 | PK | — |