Provider Demographics
NPI:1467712083
Name:SHEETS, JUDE THADDEUS (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:THADDEUS
Last Name:SHEETS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 STEWART LN
Mailing Address - Street 2:
Mailing Address - City:TRIADELPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:26059-1020
Mailing Address - Country:US
Mailing Address - Phone:304-547-1950
Mailing Address - Fax:304-547-1983
Practice Address - Street 1:450 STEWART LN
Practice Address - Street 2:
Practice Address - City:TRIADELPHIA
Practice Address - State:WV
Practice Address - Zip Code:26059-1020
Practice Address - Country:US
Practice Address - Phone:304-547-1950
Practice Address - Fax:304-547-1983
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132561183500000X
PARPI007312183500000X
WVRP0008059183500000X
LAPST.020108183500000X
LAMA.2121183500000X
PARP447601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP447601OtherPA BOARD OF PHARMACY
LAMA.2121OtherLA BOARD OF PHARMACY
LAPST.020108OtherLA BOARD OF PHARMACY
OH03132561OtherOH BOARD OF PHARMACY
WVRP0008059OtherWV BOARD OF PHARMACY
PARPI007312OtherPA BOARD OF PHARMACY