Provider Demographics
NPI:1376160606
Name:MRAZ, CHERIE (RPH)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:MRAZ
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 1:120 TORTOLANO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068-5326
Mailing Address - Country:US
Mailing Address - Phone:740-602-2245
Mailing Address - Fax:
Practice Address - Street 1:79 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2012
Practice Address - Country:US
Practice Address - Phone:603-643-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist