Provider Demographics
NPI:1952457228
Name:SERVOS, SHERRY L (RPH)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:SERVOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:410 THREE NOTCH LN
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-9727
Mailing Address - Country:US
Mailing Address - Phone:765-720-3530
Mailing Address - Fax:
Practice Address - Street 1:1600 S OHIO ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-3317
Practice Address - Country:US
Practice Address - Phone:765-342-6213
Practice Address - Fax:765-342-6851
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018929A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist