MEDICARE: HAYLEY BROOKE SHEPHERD

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
1	183500000X	Pharmacist	0202220094	VA
2	183500000X	Pharmacist	RP0012712	WV

General Provider Information

NPI Number	:	1336806033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLEY BROOKE SHEPHERD

Provider Business Mailing Address
First Line	:	12 WILLIAMTON GROVE DR
Second Line	:
City	:	ELKVIEW
State	:	WV
Zip	:	25071-7422
Country	:	US
Telephone Number	:	304-545-9782
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 ELK PLZ
Second Line	:
City	:	ELKVIEW
State	:	WV
Zip	:	25071-9602
Country	:	US
Telephone Number	:	304-965-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	11/17/2021

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Directions to “ HAYLEY BROOKE SHEPHERD ” Practice Location

Language	Start Address	Practice Location

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