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NPI Code Detail

MEDICARE: MRS. CHRISTINE MARIE SHEPARD RPH

MEDICARE: MRS. CHRISTINE MARIE SHEPARD RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist038168NY

General Provider Information

NPI Number : 1063699593
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTINE MARIE SHEPARD RPH
Provider Business Mailing Address
First Line : 1600 CEDAR ST
Second Line :
City : ELMIRA
State : NY
Zip : 14904-2948
Country : US
Telephone Number : 607-734-6407
Fax Number :
Provider Business Practice Location Address
First Line : 402 N MAIN ST
Second Line :
City : ELMIRA
State : NY
Zip : 14901-2104
Country : US
Telephone Number : 607-271-9480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2008
Last Update Date : 02/21/2011

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