Healthcare Provider Details

I. General information

NPI: 1568527679
Provider Name (Legal Business Name): SHERMAN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 KNOXVILLE AVE
BRIMFIELD IL
61517-9802
US

IV. Provider business mailing address

PO BOX 268
BRIMFIELD IL
61517-0268
US

V. Phone/Fax

Practice location:
  • Phone: 309-446-3292
  • Fax: 309-446-9696
Mailing address:
  • Phone: 309-446-3292
  • Fax: 309-446-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054006238
License Number StateIL

VIII. Authorized Official

Name: CURTIS SHERMAN
Title or Position: OWNER
Credential: RPH
Phone: 309-446-3292