Provider Demographics
NPI:1053438119
Name:PHILLIPS, SHERRILL JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHERRILL
Middle Name:JEAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29399 140TH STREET
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:IA
Mailing Address - Zip Code:50276
Mailing Address - Country:US
Mailing Address - Phone:515-438-2835
Mailing Address - Fax:
Practice Address - Street 1:1251 334TH STREET
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276
Practice Address - Country:US
Practice Address - Phone:515-438-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP15849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP15849OtherPHARMACIST LICENSE