=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841332806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL DAYON SHEPPARD PHARMD.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 07/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3793 HIGHWAY 4
-----------------------------------------------------
City | JAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32565-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-675-6990
-----------------------------------------------------
Fax | 850-675-8051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3793 HIGHWAY 4 PO BOX 575
-----------------------------------------------------
City | JAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32565-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-675-6990
-----------------------------------------------------
Fax | 850-675-8051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | PS32480
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------