Provider Demographics
NPI:1639179351
Name:WOOTEN, CHERYL B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:B
Last Name:WOOTEN
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 1:2323 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-4227
Mailing Address - Country:US
Mailing Address - Phone:251-368-7378
Mailing Address - Fax:251-368-3868
Practice Address - Street 1:400 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-3004
Practice Address - Country:US
Practice Address - Phone:251-368-7378
Practice Address - Fax:251-368-3868
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist