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General NPI Number Information
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NPI Number | 1043543341
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Entity Type | Individual
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Provider Name | CHARLES WAYNE CHERRY JR. DPH.
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Gender | Male
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 732 OLD HICKORY BLVD
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City | JACKSON
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State | TN
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Zip | 38305-2440
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Country | US
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Telephone | 731-668-3929
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Fax | 731-668-0225
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Provider Business Mailing Address
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Address Line | 1332 N HIGHLAND AVE
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City | JACKSON
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State | TN
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Zip | 38301-4019
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Country | US
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Telephone | 731-427-4992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5336
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License Number State | TN
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