Provider Demographics
NPI:1457744955
Name:ENSIGN, CHERYL ANN
Entity type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:ANN
Last Name:ENSIGN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:655 S.GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740
Mailing Address - Country:US
Mailing Address - Phone:626-857-9439
Mailing Address - Fax:
Practice Address - Street 1:655 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4107
Practice Address - Country:US
Practice Address - Phone:626-857-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist