MEDICARE: SHERRI JO SHORT

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	009738	KY

General Provider Information

NPI Number	:	1699308684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRI JO SHORT

Provider Business Mailing Address
First Line	:	106 LONGVIEW DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2232
Country	:	US
Telephone Number	:	859-200-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 LONGVIEW DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2232
Country	:	US
Telephone Number	:	859-200-5882
Fax Number	:

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

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	02/18/2020

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Directions to “ SHERRI JO SHORT ” Practice Location

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