Basic Information
| Provider Information | |||||||||
| NPI: | 1932532918 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANNINGTON | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | R. PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2490 CANNINGTON RD | ||||||||
| Address2: | |||||||||
| City: | IRON CITY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398593615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2297742532 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 409 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DONALSONVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398451511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295242596 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2013 | ||||||||
| LastUpdateDate: | 08/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 11156 | GA | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 11156 | 01 | GA | LICENSE | OTHER |