Provider Demographics
NPI:1851902712
Name:SHEPARD, ELISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 HALIBUT POINT RD
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7354
Mailing Address - Country:US
Mailing Address - Phone:907-966-2150
Mailing Address - Fax:907-966-2468
Practice Address - Street 1:705 HALIBUT POINT RD
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7354
Practice Address - Country:US
Practice Address - Phone:907-966-2150
Practice Address - Fax:907-966-2468
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00055983183500000X
AKPHAP1558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00055983OtherPHARMACY LICENSE
AKPHAP1558OtherPHARMACY LICENSE