Basic Information
| Provider Information | |||||||||
| NPI: | 1932577202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERRILL | ||||||||
| FirstName: | ARDEN | ||||||||
| MiddleName: | BRYAN | ||||||||
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| Credential: | BSPHARM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OTHELLO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993441578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094889324 | ||||||||
| FaxNumber: | 5094889433 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OTHELLO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993441578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094889324 | ||||||||
| FaxNumber: | 5094889433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH00069132 | WA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 36350 | TX | N | Pharmacy Service Providers | Pharmacist |
No ID Information.