Provider Demographics
NPI:1619091543
Name:MICHAELSON, SHERRY LYNNE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LYNNE
Last Name:MICHAELSON
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 1:5238 SWINDON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5159
Mailing Address - Country:US
Mailing Address - Phone:916-435-4152
Mailing Address - Fax:
Practice Address - Street 1:900 PLEASANT GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6126
Practice Address - Country:US
Practice Address - Phone:916-786-6603
Practice Address - Fax:916-786-8177
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46236OtherSTATE PHARMACIST LICENSE#