Healthcare Provider Details

I. General information

NPI: 1154226389
Provider Name (Legal Business Name): GAYLAN RUTH SHEPHERD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1316
LUCERNE CA
95458-1316
US

IV. Provider business mailing address

PO BOX 1316
LUCERNE CA
95458-1316
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-6643
  • Fax:
Mailing address:
  • Phone: 707-274-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY61482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: