Provider Demographics
NPI:1922370568
Name:SHEPHERD, TRICIA ANN (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:TRICIA
Middle Name:ANN
Last Name:SHEPHERD
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 1:14330 58TH ST N APT 4304
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-2816
Mailing Address - Country:US
Mailing Address - Phone:954-684-0414
Mailing Address - Fax:
Practice Address - Street 1:7610 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5424
Practice Address - Country:US
Practice Address - Phone:727-525-1361
Practice Address - Fax:727-525-8232
Is Sole Proprietor?:No
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist