Provider Demographics
NPI:1063063204
Name:SHERWOOD, NICHOLE (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 NE AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5927
Mailing Address - Country:US
Mailing Address - Phone:816-985-1488
Mailing Address - Fax:
Practice Address - Street 1:1314 24TH AVENUE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:816-985-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030637183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist