Provider Demographics
NPI:1003411679
Name:PEARL, SHERESE (RPH)
Entity Type:Individual
Prefix:
First Name:SHERESE
Middle Name:
Last Name:PEARL
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 1:975 ROSTRAVER RD
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-1946
Mailing Address - Country:US
Mailing Address - Phone:724-929-9155
Mailing Address - Fax:
Practice Address - Street 1:975 ROSTRAVER RD
Practice Address - Street 2:
Practice Address - City:ROSTRAVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15012-1946
Practice Address - Country:US
Practice Address - Phone:724-929-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist