Provider Demographics
NPI:1649398587
Name:SHEPHERD, MARILYN F (BS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:F
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BROADWAY ST
Mailing Address - Street 2:P.O. BOX 73
Mailing Address - City:THORNBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50255
Mailing Address - Country:US
Mailing Address - Phone:641-634-2084
Mailing Address - Fax:
Practice Address - Street 1:110 S D ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-3202
Practice Address - Country:US
Practice Address - Phone:641-673-0259
Practice Address - Fax:641-672-1531
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist