Provider Demographics
NPI:1710905625
Name:SHERIDAN-ELLIOTT PHARMACY INC
Entity Type:Organization
Organization Name:SHERIDAN-ELLIOTT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-896-9378
Mailing Address - Street 1:508 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-9188
Mailing Address - Country:US
Mailing Address - Phone:317-758-4171
Mailing Address - Fax:317-758-9045
Practice Address - Street 1:508 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IN
Practice Address - Zip Code:46069-9188
Practice Address - Country:US
Practice Address - Phone:317-758-4171
Practice Address - Fax:317-758-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN6003776A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100126610AMedicaid
IN100126610AMedicaid