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General NPI Number Information
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NPI Number | 1972052645
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Entity Type | Individual
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Provider Name | SHERRY CHILDERS
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Gender | Female
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 1713 S PARK AVE
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City | HERRIN
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State | IL
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Zip | 62948-4166
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Country | US
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Telephone | 618-942-6641
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Fax | 618-988-9306
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Provider Business Mailing Address
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Address Line | 5 QUAIL DR
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City | HERRIN
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State | IL
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Zip | 62948-2473
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Country | US
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Telephone | 618-694-9953
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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 | 051039434
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License Number State | IL
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