Healthcare Provider Details

I. General information

NPI: 1063507267
Provider Name (Legal Business Name): GEE SHIPMAN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WEST LAMAR
JASPER TX
75951
US

IV. Provider business mailing address

140 WEST LAMAR
JASPER TX
75951
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-4646
  • Fax: 409-384-4648
Mailing address:
  • Phone: 409-384-4646
  • Fax: 409-384-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0659280001
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BEN RALPH SHIPMAN
Title or Position: PHARMACIST OWNER
Credential: RPH
Phone: 409-384-4646