Provider Demographics
NPI:1932494598
Name:SHEPUTIS, DANIEL S (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:S
Last Name:SHEPUTIS
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 1:5120 28TH ST SE
Mailing Address - Street 2:T-2014
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2049
Mailing Address - Country:US
Mailing Address - Phone:616-222-4890
Mailing Address - Fax:
Practice Address - Street 1:5120 28TH ST SE
Practice Address - Street 2:T-2014
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2049
Practice Address - Country:US
Practice Address - Phone:616-222-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist