Provider Demographics
NPI:1093003311
Name:SHERARD, GENE STEVENSON JR (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:STEVENSON
Last Name:SHERARD
Suffix:JR
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6435 CAROLINA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2909
Mailing Address - Country:US
Mailing Address - Phone:910-392-1700
Mailing Address - Fax:910-452-2375
Practice Address - Street 1:6435 CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2909
Practice Address - Country:US
Practice Address - Phone:910-392-1700
Practice Address - Fax:910-452-2375
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC6297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCAR 7638604OtherDEA NUMBER