Provider Demographics
NPI:1689003055
Name:MALCOLM, SHERI ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:ANN
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SHERI
Other - Middle Name:ANN
Other - Last Name:RENDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5531 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2053
Mailing Address - Country:US
Mailing Address - Phone:616-954-6033
Mailing Address - Fax:
Practice Address - Street 1:5531 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2053
Practice Address - Country:US
Practice Address - Phone:616-954-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist