Provider Demographics
NPI:1952419483
Name:SHIELDS, STEPHANIE BETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BETH
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:BETH
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4273 LAKE BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083
Mailing Address - Country:US
Mailing Address - Phone:404-298-5565
Mailing Address - Fax:404-298-5565
Practice Address - Street 1:95 COLLIER RD
Practice Address - Street 2:SUITE 5015
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:678-298-3228
Practice Address - Fax:678-298-3229
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist