Provider Demographics
NPI:1548256860
Name:SHERMAN'S PHARMACY
Entity type:Organization
Organization Name:SHERMAN'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.PH./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-648-2328
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:IL
Mailing Address - Zip Code:61723-0566
Mailing Address - Country:US
Mailing Address - Phone:217-648-2328
Mailing Address - Fax:217-648-2329
Practice Address - Street 1:122 SW 1ST ST.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:IL
Practice Address - Zip Code:61723-0566
Practice Address - Country:US
Practice Address - Phone:217-648-2328
Practice Address - Fax:217-648-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361443874001Medicaid