Provider Demographics
NPI:1164134748
Name:SHEPEARD, TAYLOR MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:SHEPEARD
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 1:46655 BOOTJACK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:49945-9403
Mailing Address - Country:US
Mailing Address - Phone:906-369-1314
Mailing Address - Fax:
Practice Address - Street 1:46655 BOOTJACK RD
Practice Address - Street 2:
Practice Address - City:LAKE LINDEN
Practice Address - State:MI
Practice Address - Zip Code:49945-9403
Practice Address - Country:US
Practice Address - Phone:906-369-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist