Provider Demographics
NPI:1306034731
Name:SHEETS, DAWN MICHELLE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MICHELLE
Last Name:SHEETS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9666 OLDE US 20
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1710
Mailing Address - Country:US
Mailing Address - Phone:419-872-9126
Mailing Address - Fax:419-872-9126
Practice Address - Street 1:9666 OLDE US 20
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1710
Practice Address - Country:US
Practice Address - Phone:419-872-9126
Practice Address - Fax:419-872-9126
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-25859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2231838Medicaid
OH2231838Medicaid