# SHERIDAN PHARMACY, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sheridan Pharmacy 1155
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023181849
- **Authorized official:** JACK L HOLT RPH (OWNER)
- **Authorized official phone:** (360) 693-5879

## Contact information

- **Practice address:** 103 E MAIN ST, SHERIDAN, OR 97378-1828
- **Practice address phone:** (503) 843-2422
- **Practice address fax:** (503) 843-5043
- **Mailing address:** 916 W EVERGREEN BLVD, VANCOUVER, WA 98660-3035
- **Mailing address phone:** (360) 213-2236
- **Mailing address fax:** (360) 213-2238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | RP-0000500-CS | OR | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 10/05/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 500625416 | — | OR |