MEDICARE: SHERI LYN MCCORMICK RPH

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	S009089	AZ

General Provider Information

NPI Number	:	1518292713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERI LYN MCCORMICK RPH

Provider Business Mailing Address
First Line	:	13619 N 71ST DR
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-5092
Country	:	US
Telephone Number	:	623-486-7783
Fax Number	:	623-486-0346

Provider Business Practice Location Address
First Line	:	5116 W OLIVE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-4209
Country	:	US
Telephone Number	:	623-937-4771
Fax Number	:	623-915-9519

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

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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