Provider Demographics
NPI:1407145857
Name:SHEPHERD, WILLIAM ALAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALAN
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOLLY HILLS MALL RD
Mailing Address - Street 2:RITE AID #1436
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822
Mailing Address - Country:US
Mailing Address - Phone:606-785-4960
Mailing Address - Fax:606-785-0212
Practice Address - Street 1:100 HOLLY HILLS MALL RD
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822-0100
Practice Address - Country:US
Practice Address - Phone:606-785-4960
Practice Address - Fax:606-785-0212
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist