=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053389478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHERWOODS DRUG SHOP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2006
-----------------------------------------------------
Last Update Date | 09/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 NELSON BROGDON BLVD SUITE 190
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30518-5400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-945-9526
-----------------------------------------------------
Fax | 770-945-1282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 NELSON BROGDON BLVD SUITE 190
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30518-5400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-945-9526
-----------------------------------------------------
Fax | 770-945-1282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANICA ROBERTSON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 770-945-9526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE004296
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------