Provider Demographics
NPI:1932402591
Name:SHEPARD, TANYA ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ROSE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:ROSE
Other - Last Name:THANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4860 Y ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-1505
Mailing Address - Fax:916-734-7402
Practice Address - Street 1:4860 Y ST STE 400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-1505
Practice Address - Fax:916-734-7402
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist