1962834473 NPI number — SHERYL ANN CHISHOLM RP

Table of content: SHERYL ANN CHISHOLM RP (NPI 1962834473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962834473 NPI number — SHERYL ANN CHISHOLM RP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHISHOLM
Provider First Name:
SHERYL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHISHOLM
Provider Other First Name:
SHERYL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMACIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962834473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2907 WHITNEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTIC
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50022-9772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-243-3071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2907 WHITNEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTIC
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50022-9772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-243-3071
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2013

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:  17914 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 10863 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 2008029223 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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