Provider Demographics
NPI:1609155738
Name:KELISHADI, SHERRY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:KELISHADI
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 1:1422 MOCKINGBIRD VALLEY GRN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1364
Mailing Address - Country:US
Mailing Address - Phone:410-868-4649
Mailing Address - Fax:
Practice Address - Street 1:3001 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5901
Practice Address - Country:US
Practice Address - Phone:812-258-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024147A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist