Provider Demographics
NPI:1821384017
Name:SHEPHERD, SANDRA L (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 TRUEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-2480
Mailing Address - Country:US
Mailing Address - Phone:614-876-7089
Mailing Address - Fax:614-219-5109
Practice Address - Street 1:4211 TRUEMAN BLVD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2480
Practice Address - Country:US
Practice Address - Phone:614-876-7089
Practice Address - Fax:614-219-5109
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03125932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist