Provider Demographics
NPI:1457605529
Name:SHERTECH PHARMACY PIEDMONT, LLC
Entity type:Organization
Organization Name:SHERTECH PHARMACY PIEDMONT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-661-1001
Mailing Address - Street 1:1470 HAMPTON PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3785
Mailing Address - Country:US
Mailing Address - Phone:336-992-6853
Mailing Address - Fax:336-992-6850
Practice Address - Street 1:1470 HAMPTON PLAZA DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3785
Practice Address - Country:US
Practice Address - Phone:336-992-6853
Practice Address - Fax:336-992-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336N0007X
NC104943336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336N0007XSuppliersPharmacyNuclear Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3460564OtherNCPDP PROVIDER IDENTIFICATION NUMBER