Provider Demographics
NPI:1659132744
Name:SHERON, AIRIEL REANNA DENISE
Entity Type:Individual
Prefix:
First Name:AIRIEL
Middle Name:REANNA DENISE
Last Name:SHERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5742
Mailing Address - Country:US
Mailing Address - Phone:573-339-1700
Mailing Address - Fax:573-339-7314
Practice Address - Street 1:1 S KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5742
Practice Address - Country:US
Practice Address - Phone:573-339-1700
Practice Address - Fax:573-339-7314
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023038902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist