Healthcare Provider Details

I. General information

NPI: 1104270206
Provider Name (Legal Business Name): SHERMAN AREA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MAIN ST
SHERMAN NY
14781
US

IV. Provider business mailing address

8629 HIGHLAND AVE
BROCTON NY
14716-9713
US

V. Phone/Fax

Practice location:
  • Phone: 716-761-6876
  • Fax: 716-761-6224
Mailing address:
  • Phone: 716-969-4334
  • Fax: 716-761-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034331
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number34331
License Number StateNY

VIII. Authorized Official

Name: CHRISTAN NYWEIDE
Title or Position: PRESIDENT /OWNER
Credential:
Phone: 716-969-4334