Provider Demographics
NPI:1467737478
Name:REHBERG, CHERYL MALISSE (RPH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MALISSE
Last Name:REHBERG
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 1:1809 WINDSONG CIR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4108 AMON CARTER BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76155-2649
Practice Address - Country:US
Practice Address - Phone:817-923-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist