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General NPI Number Information
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NPI Number | 1194717645
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Entity Type | Individual
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Provider Name | MARTHA JANE SHEPARD D.PH.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7723 CLEARVIEW CHURCH LN
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City | LYLES
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State | TN
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Zip | 37098-1609
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Country | US
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Telephone | 931-670-6035
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Fax |
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Provider Business Mailing Address
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Address Line | 204 MCCREARY HTS
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City | DICKSON
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State | TN
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Zip | 37055-1217
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Country | US
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Telephone | 615-446-9782
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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 | 686
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License Number State | TN
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