Provider Demographics
NPI:1417482928
Name:SHERIDAN, PHILIP JAMES III (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JAMES
Last Name:SHERIDAN
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 N EWING ST
Mailing Address - Street 2:KROGER PHARMACY
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3372
Mailing Address - Country:US
Mailing Address - Phone:740-654-1763
Mailing Address - Fax:740-654-1699
Practice Address - Street 1:401 N EWING ST
Practice Address - Street 2:KROGER PHARMACY
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3372
Practice Address - Country:US
Practice Address - Phone:740-654-1763
Practice Address - Fax:740-654-1699
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH03321843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist