Provider Demographics
NPI:1548535404
Name:SAMUEL, SHERRY N (PHARMD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:N
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 WOODFIELD TRCE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6080
Mailing Address - Country:US
Mailing Address - Phone:770-482-9048
Mailing Address - Fax:
Practice Address - Street 1:199 HILDERBRAND DR NE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3855
Practice Address - Country:US
Practice Address - Phone:404-781-1800
Practice Address - Fax:404-781-1807
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist