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Organization
SHERIDAN PHARMACY, INC
Active
Organization
SHERIDAN PHARMACY, INC
Active
Other names
Sheridan Pharmacy 1155
Organization subpart
No
Provider details
NPI number
Authorized official
JACK L HOLT RPH (OWNER)
(360) 693-5879
Entity
Organization
Contact information
Practice address
103 E MAIN ST, SHERIDAN, OR 97378-1828
(503) 843-2422
(503) 843-5043
Mailing address
916 W EVERGREEN BLVD, VANCOUVER, WA 98660-3035
(360) 213-2236
(360) 213-2238
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
RP-0000500-CS
OR
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500625416
—
OR
Enumeration date
11/17/2006
Last updated
10/05/2010
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