Provider Demographics
NPI:1740871326
Name:SHEARER, SAMUEL EARL (RPH, BCGP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EARL
Last Name:SHEARER
Suffix:
Gender:M
Credentials:RPH, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:IL
Mailing Address - Zip Code:62979-0146
Mailing Address - Country:US
Mailing Address - Phone:618-272-3841
Mailing Address - Fax:618-272-3851
Practice Address - Street 1:101 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:IL
Practice Address - Zip Code:62979
Practice Address - Country:US
Practice Address - Phone:619-272-3841
Practice Address - Fax:618-272-3851
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2897581835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric