Provider Demographics
NPI:1841871415
Name:SHEPARD, JO ELLEN E (PHARM D)
Entity type:Individual
Prefix:
First Name:JO ELLEN
Middle Name:E
Last Name:SHEPARD
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 1:422 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4343
Mailing Address - Country:US
Mailing Address - Phone:970-521-0190
Mailing Address - Fax:970-522-1432
Practice Address - Street 1:422 MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4343
Practice Address - Country:US
Practice Address - Phone:970-521-0190
Practice Address - Fax:970-522-1432
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist