Provider Demographics
NPI:1003428954
Name:SHEPHERD, BEAR L (PHARMD)
Entity Type:Individual
Prefix:
First Name:BEAR
Middle Name:L
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 KRISTI DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5778
Mailing Address - Country:US
Mailing Address - Phone:618-381-6512
Mailing Address - Fax:
Practice Address - Street 1:232 GILL ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2465
Practice Address - Country:US
Practice Address - Phone:865-982-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000041605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist