Provider Demographics
NPI:1265975189
Name:BERRY, CHERYL (RPH)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-2902
Mailing Address - Country:US
Mailing Address - Phone:270-338-7300
Mailing Address - Fax:270-338-3807
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-2902
Practice Address - Country:US
Practice Address - Phone:270-338-7300
Practice Address - Fax:270-338-3807
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist