MEDICARE: SHERRY CHILDERS

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	051039434	IL

General Provider Information

NPI Number	:	1972052645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY CHILDERS

Provider Business Mailing Address
First Line	:	5 QUAIL DR
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-2473
Country	:	US
Telephone Number	:	618-694-9953
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 S PARK AVE
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-4166
Country	:	US
Telephone Number	:	618-942-6641
Fax Number	:	618-988-9306

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

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	09/23/2016

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Directions to “ SHERRY CHILDERS ” Practice Location

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