MEDICARE: SUE SHERMAN 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
1	183500000X	Pharmacist	1528791701	UT

General Provider Information

NPI Number	:	1265546998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE SHERMAN RPH

Provider Business Mailing Address
First Line	:	9578 ANGUS DR
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-9523
Country	:	US
Telephone Number	:	801-213-9250
Fax Number	:	801-213-9255

Provider Business Practice Location Address
First Line	:	3730 W 4700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-3457
Country	:	US
Telephone Number	:	801-213-9250
Fax Number	:	801-213-9255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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Directions to “ SUE SHERMAN RPH” Practice Location

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