Provider Demographics
NPI:1033491840
Name:SHIELDS, KEE EDMONDSON
Entity Type:Individual
Prefix:
First Name:KEE
Middle Name:EDMONDSON
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BATSELL DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-8939
Mailing Address - Country:US
Mailing Address - Phone:502-348-2985
Mailing Address - Fax:502-348-7067
Practice Address - Street 1:824 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1747
Practice Address - Country:US
Practice Address - Phone:502-348-2985
Practice Address - Fax:502-348-7067
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist