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General NPI Number Information
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NPI Number | 1265547293
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Entity Type | Organization
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Legal Business Name | SHERIDAN VILLAGE PHARMACY LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 617 S MAIN
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City | SHERIDAN
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State | MI
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Zip | 48884
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Country | US
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Telephone | 989-291-3636
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Fax | 989-291-3330
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Provider Business Mailing Address
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Address Line | PO BOX 314
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City | SHERIDAN
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State | MI
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Zip | 48884-0314
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Country | US
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Telephone | 989-291-3636
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Fax | 989-291-3330
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Authorized Official
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Title or Position | CEP
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Name | PHILIP MEITZ
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Credential | BS
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Telephone | 989-291-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008424
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License Number State | MI
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