Provider Demographics
NPI:1083755136
Name:SHEETS, MICHAEL CARTER (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CARTER
Last Name:SHEETS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 CLARK STATION RD
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-8720
Mailing Address - Country:US
Mailing Address - Phone:502-254-9638
Mailing Address - Fax:
Practice Address - Street 1:10216 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-3616
Practice Address - Country:US
Practice Address - Phone:502-267-7453
Practice Address - Fax:502-267-7455
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007709183500000X
TX21401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist