MEDICARE: AMY SHEPPARD

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	PS35326	FL
2	183500000X	Pharmacist	26019916A	IN

General Provider Information

NPI Number	:	1568816007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SHEPPARD

Provider Business Mailing Address
First Line	:	503 E ALTAMONTE DR
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4702
Country	:	US
Telephone Number	:	407-831-3454
Fax Number	:	407-834-2909

Provider Business Practice Location Address
First Line	:	503 E ALTAMONTE DR
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4702
Country	:	US
Telephone Number	:	407-831-3454
Fax Number	:	407-834-2909

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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