Provider Demographics
NPI:1578584538
Name:SHERRILLS CORPORATION
Entity Type:Organization
Organization Name:SHERRILLS CORPORATION
Other - Org Name:SHERILLS PHARMACY AND GIFTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-584-3353
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-3973
Mailing Address - Country:US
Mailing Address - Phone:580-584-3353
Mailing Address - Fax:580-584-9459
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-3973
Practice Address - Country:US
Practice Address - Phone:580-584-3353
Practice Address - Fax:580-584-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2550753336C0003X, 3336C0003X, 3336C0003X
3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072694OtherPK
OK200076970AMedicaid
OK90003918042Medicaid