Healthcare Provider Details

I. General information

NPI: 1154801959
Provider Name (Legal Business Name): ANDREW CHRISTOPHER SHEPHERD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 E REPUBLIC RD
SPRINGFIELD MO
65804-6507
US

IV. Provider business mailing address

560 W BRYANT APT B310
SPRINGFIELD MO
65810-8320
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-6880
  • Fax:
Mailing address:
  • Phone: 417-920-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2018028861
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: