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NPI Code Detail

MEDICARE: ROBERT SHEPARD

MEDICARE: ROBERT SHEPARD
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
1183500000XPharmacist39291TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
139291OTHERTNPHARMACIST LICENSE

General Provider Information

NPI Number : 1568845410
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT SHEPARD
Provider Business Mailing Address
First Line : 6304 STOCKTON DR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37416-3207
Country : US
Telephone Number : 423-903-9866
Fax Number :
Provider Business Practice Location Address
First Line : 3569 BRAINERD RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37411-2708
Country : US
Telephone Number : 423-629-7323
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2015
Last Update Date : 07/16/2015

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