=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437571296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL SHERRY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2014
-----------------------------------------------------
Last Update Date | 01/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1024 CENTRAL PARK DR
-----------------------------------------------------
City | STEAMBOAT SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80487-8813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-870-1100
-----------------------------------------------------
Fax | 970-871-2315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1024 CENTRAL PARK DR
-----------------------------------------------------
City | STEAMBOAT SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80487-8813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-870-1100
-----------------------------------------------------
Fax | 970-871-2315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0016602
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------