Provider Demographics
NPI:1356761167
Name:VIDAL, SHEILA (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:VIDAL
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 1:3590 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4614
Mailing Address - Country:US
Mailing Address - Phone:409-813-8452
Mailing Address - Fax:409-980-5883
Practice Address - Street 1:3590 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4614
Practice Address - Country:US
Practice Address - Phone:409-813-8452
Practice Address - Fax:409-980-5883
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist