MEDICARE: MRS. SHERRIE LYNNE MACDERMOD B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10145	NC

General Provider Information

NPI Number	:	1194962084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRIE LYNNE MACDERMOD B.S.

Provider Business Mailing Address
First Line	:	143 PLANTATION DR
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-5820
Country	:	US
Telephone Number	:	704-664-9275
Fax Number	:

Provider Business Practice Location Address
First Line	:	947 N MAIN ST
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28115-2355
Country	:	US
Telephone Number	:	704-664-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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