Provider Demographics
NPI:1114186129
Name:SHEPHERD, DON MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:MICHAEL
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-8018
Mailing Address - Country:US
Mailing Address - Phone:912-285-4630
Mailing Address - Fax:912-283-8929
Practice Address - Street 1:1803 KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8018
Practice Address - Country:US
Practice Address - Phone:912-285-4630
Practice Address - Fax:912-283-8929
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99711835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist