Provider Demographics
NPI:1154723906
Name:THEOLOGOS, SHERRY (RPH)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:THEOLOGOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-2508
Mailing Address - Country:US
Mailing Address - Phone:228-467-4717
Mailing Address - Fax:228-467-1061
Practice Address - Street 1:460 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2508
Practice Address - Country:US
Practice Address - Phone:228-467-4717
Practice Address - Fax:228-467-1061
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE07429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist