MEDICARE: MRS. JILL M SHEETS P.D.

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	183500000X	Pharmacist	06978	AR

General Provider Information

NPI Number	:	1982713244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL M SHEETS P.D.

Provider Business Mailing Address
First Line	:	10390 OAK GROVE RD
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-8968
Country	:	US
Telephone Number	:	479-229-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 UNION ST
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-3429
Country	:	US
Telephone Number	:	479-229-4811
Fax Number	:	479-229-5871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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