Provider Demographics
NPI:1023011251
Name:SPIRES, SHERRILL (PHD, RPH)
Entity Type:Individual
Prefix:DR
First Name:SHERRILL
Middle Name:
Last Name:SPIRES
Suffix:
Gender:F
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:39010 COMPTCHE UKIAH RD
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-0499
Mailing Address - Country:US
Mailing Address - Phone:585-742-1249
Mailing Address - Fax:
Practice Address - Street 1:490 S MAIN ST
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-4806
Practice Address - Country:US
Practice Address - Phone:707-964-1848
Practice Address - Fax:707-964-9513
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044237183500000X
CA59393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist