Provider Demographics
NPI:1912204421
Name:SHIELDS, JESSICA ANN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 W FLOYD BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1805
Mailing Address - Country:US
Mailing Address - Phone:864-902-0374
Mailing Address - Fax:864-902-8865
Practice Address - Street 1:837 W FLOYD BAKER BLVD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1805
Practice Address - Country:US
Practice Address - Phone:864-902-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist