Provider Demographics
NPI:1750681961
Name:GILLIAM, CHERI
Entity Type:Individual
Prefix:DR
First Name:CHERI
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CHERI
Other - Middle Name:
Other - Last Name:SHIMKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 BARNES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-0910
Mailing Address - Country:US
Mailing Address - Phone:662-844-5247
Mailing Address - Fax:662-844-5417
Practice Address - Street 1:930 BARNES CROSSING RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0910
Practice Address - Country:US
Practice Address - Phone:662-844-5247
Practice Address - Fax:662-844-5417
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-010403183500000X
ARPD10558183500000X
TN29544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist