Provider Demographics
NPI:1710257761
Name:SHEPARD, THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 ROYAL PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3749
Mailing Address - Country:US
Mailing Address - Phone:615-889-7664
Mailing Address - Fax:
Practice Address - Street 1:801 ROYAL PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3749
Practice Address - Country:US
Practice Address - Phone:615-889-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017011A183500000X
TN26091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist