MEDICARE: DR. CHERYL N MISTRY PHARM.D, MBA

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	RPH022747	GA

General Provider Information

NPI Number	:	1831437227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL N MISTRY PHARM.D, MBA

Provider Business Mailing Address
First Line	:	603 IVANHOE CLOSE
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-8792
Country	:	US
Telephone Number	:	404-610-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	11155 TARA BLVD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-1672
Country	:	US
Telephone Number	:	770-473-4779
Fax Number	:

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

Provider Enumeration Date	:	01/21/2013
Last Update Date	:	01/21/2013

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