MEDICARE: SHEILA GARDNER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	29807	TX

General Provider Information

NPI Number	:	1316578586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA GARDNER RPH

Provider Business Mailing Address
First Line	:	2308 PATRIOT
Second Line	:
City	:	MELISSA
State	:	TX
Zip	:	75454-3129
Country	:	US
Telephone Number	:	214-793-0145
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 INDEPENDENCE PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-5755
Country	:	US
Telephone Number	:	972-491-2596
Fax Number	:	972-491-2468

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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