Provider Demographics
NPI:1013019991
Name:TENNANT, CHERYL LYNN (BS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:TENNANT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-8742
Mailing Address - Country:US
Mailing Address - Phone:724-238-9791
Mailing Address - Fax:
Practice Address - Street 1:113 S FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1163
Practice Address - Country:US
Practice Address - Phone:724-238-6988
Practice Address - Fax:724-238-7781
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038792R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP038792ROtherPHARMACIST LICENSE
WVRP0004234OtherPHARMACIST LICENSE