=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083793319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL D SHERRY RPH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CVS DR
-----------------------------------------------------
City | WOONSOCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02895-6146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-770-5983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 DOWNS RD
-----------------------------------------------------
City | DOUGLAS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01516-2581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 24183
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------