Provider Demographics
NPI:1659557692
Name:SHERWOOD, BRETT KRISTOPHER
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:KRISTOPHER
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 STATE HIGHWAY 7 STE 1
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2050
Mailing Address - Country:US
Mailing Address - Phone:607-432-8636
Mailing Address - Fax:607-433-0373
Practice Address - Street 1:5626 STATE HIGHWAY 7 STE 1
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2050
Practice Address - Country:US
Practice Address - Phone:607-432-8636
Practice Address - Fax:607-433-0373
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00572601Medicaid