Provider Demographics
NPI:1780614479
Name:SHERN DRUG INC
Entity type:Organization
Organization Name:SHERN DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-768-4244
Mailing Address - Street 1:300 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2242
Mailing Address - Country:US
Mailing Address - Phone:801-768-4244
Mailing Address - Fax:801-768-9269
Practice Address - Street 1:300 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2242
Practice Address - Country:US
Practice Address - Phone:801-768-4244
Practice Address - Fax:801-768-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6492942-1703183500000X, 3336C0003X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6463140001Medicare NSC