Provider Demographics
NPI:1073126504
Name:SHOUPE, EMILY MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:SHOUPE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 FELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-1949
Mailing Address - Country:US
Mailing Address - Phone:574-514-2379
Mailing Address - Fax:
Practice Address - Street 1:1010 E IRELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2665
Practice Address - Country:US
Practice Address - Phone:574-299-0154
Practice Address - Fax:574-299-2840
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5351012203390200000X
IN45020507A390200000X
IN26029648A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program