Provider Demographics
NPI:1477683449
Name:SHELDON, SCOT DOUGLAS (RPH)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:DOUGLAS
Last Name:SHELDON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 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
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302025598OtherPHARMACIST LICENSE NUMBER