Provider Demographics
NPI:1770133076
Name:DAIGREPONT, SHERLYN
Entity type:Individual
Prefix:
First Name:SHERLYN
Middle Name:
Last Name:DAIGREPONT
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 1:20489 STATE HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4369
Mailing Address - Country:US
Mailing Address - Phone:251-928-9073
Mailing Address - Fax:
Practice Address - Street 1:20489 STATE HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-4369
Practice Address - Country:US
Practice Address - Phone:251-928-9073
Practice Address - Fax:251-928-9075
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist