Provider Demographics
NPI:1871019885
Name:SHIELDS, STEVEN DEWITT (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DEWITT
Last Name:SHIELDS
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 1:200 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-4429
Mailing Address - Country:US
Mailing Address - Phone:601-939-2958
Mailing Address - Fax:601-939-4489
Practice Address - Street 1:200 MARKET PL
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-4429
Practice Address - Country:US
Practice Address - Phone:601-939-2958
Practice Address - Fax:609-394-4448
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist