Healthcare Provider Details

I. General information

NPI: 1194039115
Provider Name (Legal Business Name): SHERRY-ANN RENEE MARSHALL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GLENLAKE PKWY NE
ATLANTA GA
30328-3473
US

IV. Provider business mailing address

20 GLENLAKE PKWY NE
ATLANTA GA
30328-3473
US

V. Phone/Fax

Practice location:
  • Phone: 770-677-5869
  • Fax:
Mailing address:
  • Phone: 770-677-5869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number023070
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: