Provider Demographics
NPI:1871180851
Name:PETERSON, CHERRYL ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHERRYL
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17444 NAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:SABILLASVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21780-9717
Mailing Address - Country:US
Mailing Address - Phone:302-682-3005
Mailing Address - Fax:
Practice Address - Street 1:17444 NAYLOR RD
Practice Address - Street 2:
Practice Address - City:SABILLASVILLE
Practice Address - State:MD
Practice Address - Zip Code:21780-9717
Practice Address - Country:US
Practice Address - Phone:302-682-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist