Healthcare Provider Details

I. General information

NPI: 1851647515
Provider Name (Legal Business Name): SHEPPARD APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 HIGHWAY 4
JAY FL
32565-1756
US

IV. Provider business mailing address

PO BOX 575
JAY FL
32565-0575
US

V. Phone/Fax

Practice location:
  • Phone: 850-675-6990
  • Fax: 850-675-6991
Mailing address:
  • Phone: 850-675-6990
  • Fax: 850-675-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26280
License Number StateFL

VIII. Authorized Official

Name: DANIEL SHEPPARD
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 850-675-6990