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General NPI Number Information
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NPI Number | 1851647515
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Entity Type | Organization
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Legal Business Name | SHEPPARD APOTHECARY
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 3793 HIGHWAY 4
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City | JAY
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State | FL
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Zip | 32565-1756
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Country | US
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Telephone | 850-675-6990
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Fax | 850-675-6991
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Provider Business Mailing Address
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Address Line | PO BOX 575
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City | JAY
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State | FL
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Zip | 32565-0575
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Country | US
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Telephone | 850-675-6990
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Fax | 850-675-6991
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DANIEL SHEPPARD
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Credential | PHARMD
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Telephone | 850-675-6990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH26280
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License Number State | FL
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