Provider Demographics
NPI:1417294885
Name:CHESHIRE, MARYANN (RPH)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:CHESHIRE
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 1:990 BIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6118
Mailing Address - Country:US
Mailing Address - Phone:541-772-3461
Mailing Address - Fax:
Practice Address - Street 1:990 BIDDLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6118
Practice Address - Country:US
Practice Address - Phone:541-772-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0008504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH0008504OtherSTATE PHARMACIST LICENSE