1023011251 NPI number — DR. SHERRILL SPIRES PH.D., RPH

Table of content: KENDALL L POWERS PHARM.D. (NPI 1609089499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023011251 NPI number — DR. SHERRILL SPIRES PH.D., RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPIRES
Provider First Name:
SHERRILL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023011251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 499
Provider Second Line Business Mailing Address:
39010 COMPTCHE UKIAH RD
Provider Business Mailing Address City Name:
MENDOCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95460-0499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-742-1249
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 S MAIN ST
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY
Provider Business Practice Location Address City Name:
FORT BRAGG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95437-4806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-964-1848
Provider Business Practice Location Address Fax Number:
707-964-9513
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  044237 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 59393 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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