Provider Demographics
NPI:1356456701
Name:ROBERT SHIEPE
Entity Type:Organization
Organization Name:ROBERT SHIEPE
Other - Org Name:BOBS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIEPE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-838-7292
Mailing Address - Street 1:6136 VENICE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2221
Mailing Address - Country:US
Mailing Address - Phone:310-838-7292
Mailing Address - Fax:310-838-7293
Practice Address - Street 1:6136 VENICE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2221
Practice Address - Country:US
Practice Address - Phone:310-838-7292
Practice Address - Fax:310-838-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336M0002X, 3336S0011X
CAPHY341073336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0589082OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA341070Medicaid
0589082OtherNCPDP PROVIDER IDENTIFICATION NUMBER