Provider Demographics
NPI:1437320439
Name:SDS PHARMACY
Entity Type:Organization
Organization Name:SDS PHARMACY
Other - Org Name:SHELDON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-387-4244
Mailing Address - Street 1:25 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097-3317
Mailing Address - Country:US
Mailing Address - Phone:810-387-4244
Mailing Address - Fax:810-387-2605
Practice Address - Street 1:25 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097-3317
Practice Address - Country:US
Practice Address - Phone:810-387-4244
Practice Address - Fax:810-387-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5142620002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies