Provider Demographics
NPI:1508468422
Name:PETRAROLI, SHERRY (RPH)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:PETRAROLI
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:CHERRY LOG
Mailing Address - State:GA
Mailing Address - Zip Code:30522-0303
Mailing Address - Country:US
Mailing Address - Phone:678-428-9594
Mailing Address - Fax:
Practice Address - Street 1:6020 APPALACHIAN HWY
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4283
Practice Address - Country:US
Practice Address - Phone:706-632-2244
Practice Address - Fax:706-632-4440
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist