Provider Demographics
NPI:1003106022
Name:MARKS-SHEPARD, LIZABETH LEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LIZABETH
Middle Name:LEE
Last Name:MARKS-SHEPARD
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 1:11030 S 200 W
Mailing Address - Street 2:
Mailing Address - City:BROOKSTON
Mailing Address - State:IN
Mailing Address - Zip Code:47923-8217
Mailing Address - Country:US
Mailing Address - Phone:765-563-0013
Mailing Address - Fax:
Practice Address - Street 1:11030 S 200 W
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:IN
Practice Address - Zip Code:47923-8217
Practice Address - Country:US
Practice Address - Phone:765-563-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015203A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist