Provider Demographics
NPI:1437753514
Name:SHEPHERD, JULENE RENAE
Entity Type:Individual
Prefix:
First Name:JULENE
Middle Name:RENAE
Last Name:SHEPHERD
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 1:685 S WAPAK RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-9404
Mailing Address - Country:US
Mailing Address - Phone:419-225-7823
Mailing Address - Fax:
Practice Address - Street 1:2620 W BREESE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1553
Practice Address - Country:US
Practice Address - Phone:419-991-0010
Practice Address - Fax:419-991-2122
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist