Provider Demographics
NPI:1669070488
Name:GEORGE, SHERRY SAJI
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:SAJI
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 SUGAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-8338
Mailing Address - Country:US
Mailing Address - Phone:209-481-0895
Mailing Address - Fax:
Practice Address - Street 1:1201 W MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-3027
Practice Address - Country:US
Practice Address - Phone:209-599-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist