Provider Demographics
NPI:1477635845
Name:BOLDEN, SHERRY (CPHT)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PINEWAY CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-3810
Mailing Address - Country:US
Mailing Address - Phone:423-753-3875
Mailing Address - Fax:
Practice Address - Street 1:208 SUNCREST ST
Practice Address - Street 2:SUITE1
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-3494
Practice Address - Country:US
Practice Address - Phone:423-477-3847
Practice Address - Fax:423-477-4392
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN290100104071955183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician