Provider Demographics
NPI:1003199787
Name:WULLER, SHERRY A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:A
Last Name:WULLER
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 1:110 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1222
Mailing Address - Country:US
Mailing Address - Phone:618-651-1204
Mailing Address - Fax:618-651-1217
Practice Address - Street 1:110 WALNUT ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1222
Practice Address - Country:US
Practice Address - Phone:618-651-1204
Practice Address - Fax:618-651-1217
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287750183500000X
MO2003030477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist