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General NPI Number Information
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NPI Number | 1043107899
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Entity Type | Individual
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Provider Name | JAY SHEPPARD
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Gender |
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 11701 ABERCORN ST
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City | SAVANNAH
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State | GA
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Zip | 31419-1905
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Country | US
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Telephone | 912-925-4117
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Fax |
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Provider Business Mailing Address
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Address Line | 410 GOWEN DR
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City | WOODBINE
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State | GA
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Zip | 31569-4260
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Country | US
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Telephone | 912-674-6157
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH035543
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License Number State | GA
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