Provider Demographics
NPI:1851647515
Name:SHEPPARD APOTHECARY
Entity Type:Organization
Organization Name:SHEPPARD APOTHECARY
Other - Org Name:ROYAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-675-6990
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-0575
Mailing Address - Country:US
Mailing Address - Phone:850-675-6990
Mailing Address - Fax:850-675-6991
Practice Address - Street 1:3793 HIGHWAY 4
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1756
Practice Address - Country:US
Practice Address - Phone:850-675-6990
Practice Address - Fax:850-675-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH262803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136298OtherPK
FL006680400Medicaid
AL157055Medicaid
FL006680400Medicaid