Provider Demographics
NPI:1578234217
Name:SPERRY, AUTUMN VICTORIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:VICTORIA
Last Name:SPERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ODARA DR APT 206
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-3167
Mailing Address - Country:US
Mailing Address - Phone:276-202-6317
Mailing Address - Fax:
Practice Address - Street 1:2004 WARDS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5310
Practice Address - Country:US
Practice Address - Phone:434-832-0935
Practice Address - Fax:434-832-0971
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist