Provider Demographics
NPI:1427496728
Name:SERMONS, SHANDA LATRELL (PHARMD)
Entity type:Individual
Prefix:MS
First Name:SHANDA
Middle Name:LATRELL
Last Name:SERMONS
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 1:2551 E PINETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4865
Mailing Address - Country:US
Mailing Address - Phone:229-228-6419
Mailing Address - Fax:229-228-6423
Practice Address - Street 1:2551 E PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4865
Practice Address - Country:US
Practice Address - Phone:229-228-6419
Practice Address - Fax:229-228-6423
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027081183500000X
FLPS49999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist