Provider Demographics
NPI:1033417530
Name:SHPH LLC
Entity Type:Organization
Organization Name:SHPH LLC
Other - Org Name:SHEPHERDSTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-876-9966
Mailing Address - Street 1:7670 MARTINSBURG PIKE
Mailing Address - Street 2:#2
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-3698
Mailing Address - Country:US
Mailing Address - Phone:304-876-9966
Mailing Address - Fax:304-876-6655
Practice Address - Street 1:7670 MARTINSBURG PIKE
Practice Address - Street 2:#2
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-3698
Practice Address - Country:US
Practice Address - Phone:304-876-9966
Practice Address - Fax:304-876-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05524173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5055430OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WV3810020224Medicaid
WV6604990001Medicare NSC