Provider Demographics
NPI:1023394921
Name:HISEY, CHERI KAY (RPH)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:KAY
Last Name:HISEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 BRAVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-2968
Mailing Address - Country:US
Mailing Address - Phone:702-568-6624
Mailing Address - Fax:702-568-6624
Practice Address - Street 1:1701 N GREEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5885
Practice Address - Country:US
Practice Address - Phone:702-897-5884
Practice Address - Fax:702-897-4797
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14030183500000X
NMRP00003786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist