Provider Demographics
NPI:1669863452
Name:SHEPARD, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SHEPARD
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 1:1075 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1308
Mailing Address - Country:US
Mailing Address - Phone:860-907-3069
Mailing Address - Fax:
Practice Address - Street 1:1075 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1308
Practice Address - Country:US
Practice Address - Phone:860-907-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician