Provider Demographics
NPI:1942605571
Name:SHOUP, EMILY (PHARMD, BS)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:
Last Name:SHOUP
Suffix:
Gender:F
Credentials:PHARMD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 BIRCH RUN RD
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-9613
Mailing Address - Country:US
Mailing Address - Phone:989-624-1665
Mailing Address - Fax:989-624-1665
Practice Address - Street 1:9515 BIRCH RUN RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-9613
Practice Address - Country:US
Practice Address - Phone:989-624-1665
Practice Address - Fax:989-624-1665
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist