Provider Demographics
NPI:1346334638
Name:SHERROD, PHILLIP CORDELL (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:CORDELL
Last Name:SHERROD
Suffix:
Gender:M
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:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:FELDA
Mailing Address - State:FL
Mailing Address - Zip Code:33930-0427
Mailing Address - Country:US
Mailing Address - Phone:239-658-3062
Mailing Address - Fax:239-658-3063
Practice Address - Street 1:1454 MADISON AVE W
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2200
Practice Address - Country:US
Practice Address - Phone:239-658-3062
Practice Address - Fax:239-658-3063
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 10526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist