Provider Demographics
NPI:1457688632
Name:SHEPHERD, TIMOTHY (PHARM, D)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:M
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 1:3052 SAWTOOTH DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4204
Mailing Address - Country:US
Mailing Address - Phone:214-684-5859
Mailing Address - Fax:
Practice Address - Street 1:438 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-2204
Practice Address - Country:US
Practice Address - Phone:214-941-1197
Practice Address - Fax:214-941-5301
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist