Organization
ROBIN GODFREY TERRERO
Active
Other names
WELLNESS STORE COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN TERRERO RPH (PIC)
(423) 476-4312
Entity
Organization
Contact information
Practice address
3555 KEITH ST NW STE 210, CLEVELAND, TN 37312-4375
(423) 476-4312
(423) 476-7982
Mailing address
3555 KEITH ST NW STE 210, CLEVELAND, TN 37312-4375
(423) 476-4312
(423) 476-7982
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
3223
TN
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452909
—
TN
01
—
2092295
PK
—
Enumeration date
12/05/2005
Last updated
04/03/2013
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