MEDICARE: ROBERT SHIEPE

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	3336C0003X	Community/Retail Pharmacy
2	3336M0002X	Mail Order Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336L0003X	Long Term Care Pharmacy	PHY34107	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0589082	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356456701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT SHIEPE

Provider Business Mailing Address
First Line	:	6136 VENICE BLVD
Second Line	:	STE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2221
Country	:	US
Telephone Number	:	310-838-7292
Fax Number	:	310-838-7293

Provider Business Practice Location Address
First Line	:	6136 VENICE BLVD
Second Line	:	STE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2221
Country	:	US
Telephone Number	:	310-838-7292
Fax Number	:	310-838-7293

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	BOB SHIEPE
Credential	:	RPH
Telephone Number	:	310-838-7292

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	06/22/2011

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Directions to “ROBERT SHIEPE ” Practice Location

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