Provider Demographics
NPI:1659643245
Name:SHEPHERD, JUNIOR ANTHONY (PHARM D)
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:ANTHONY
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 ENGLENOOK DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3287
Mailing Address - Country:US
Mailing Address - Phone:321-695-6043
Mailing Address - Fax:
Practice Address - Street 1:1700 N NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-4504
Practice Address - Country:US
Practice Address - Phone:386-532-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist