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NPI Code Detail

MEDICARE: MS. CHERYL A WATERWORTH RPH

MEDICARE: MS. CHERYL A WATERWORTH RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist12138WI

General Provider Information

NPI Number : 1063793701
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHERYL A WATERWORTH RPH
Provider Business Mailing Address
First Line : 275 DAVISON DR
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-2034
Country : US
Telephone Number : 608-837-8566
Fax Number :
Provider Business Practice Location Address
First Line : 275 DAVISON DR
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-2034
Country : US
Telephone Number : 608-837-8566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2011
Last Update Date : 09/08/2011

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Directions to “ MS. CHERYL A WATERWORTH RPH” Practice Location

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