Healthcare Provider Details

I. General information

NPI: 1912518796
Provider Name (Legal Business Name): DANA VIOLA SHEPHERD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA VIOLA CAIRNS

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 11/27/2023
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

1548 CROWN RD
PETALUMA CA
94954-1487
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: