Provider Demographics
NPI:1801920756
Name:SHERRILL, BETTY JEAN (DPH)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4135
Mailing Address - Country:US
Mailing Address - Phone:931-707-7960
Mailing Address - Fax:
Practice Address - Street 1:1180 WEST AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4148
Practice Address - Country:US
Practice Address - Phone:931-707-3620
Practice Address - Fax:931-484-7393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC6522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist