Provider Demographics
NPI:1639765258
Name:SHELDON, JAMIE (RPH)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SHELDON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 W MURIEL DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3693
Mailing Address - Country:US
Mailing Address - Phone:623-297-7079
Mailing Address - Fax:
Practice Address - Street 1:18591 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1251
Practice Address - Country:US
Practice Address - Phone:602-789-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist