Provider Demographics
NPI:1134669864
Name:SHEARER, STEPHEN (RPH, MS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SHEARER
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 HOLLY RESERVE PKWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8861
Mailing Address - Country:US
Mailing Address - Phone:770-331-8944
Mailing Address - Fax:
Practice Address - Street 1:132 HOLLY RESERVE PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8861
Practice Address - Country:US
Practice Address - Phone:770-331-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0173641835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RPH17364OtherPHARMACY LICENCE