Provider Demographics
NPI:1962834473
Name:CHISHOLM, SHERYL ANN (RP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:
Other - Last Name:CHISHOLM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:2907 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-9772
Mailing Address - Country:US
Mailing Address - Phone:712-243-3071
Mailing Address - Fax:
Practice Address - Street 1:2907 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-9772
Practice Address - Country:US
Practice Address - Phone:712-243-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17914183500000X
NE10863183500000X
MO2008029223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist