Provider Demographics
NPI:1952610727
Name:SHERRILL, JERRY DALE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:DALE
Last Name:SHERRILL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-9284
Mailing Address - Country:US
Mailing Address - Phone:850-359-6619
Mailing Address - Fax:850-684-1049
Practice Address - Street 1:8440 NEVADA ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-9284
Practice Address - Country:US
Practice Address - Phone:850-359-6619
Practice Address - Fax:850-684-1049
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2021-10-18
Deactivation Date:2021-09-27
Deactivation Code:
Reactivation Date:2021-10-18
Provider Licenses
StateLicense IDTaxonomies
LA18373183500000X
FL44644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist