MEDICARE: THOMAS 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
1	183500000X	Pharmacist	26017011A	IN
2	183500000X	Pharmacist	26091	TN

General Provider Information

NPI Number	:	1710257761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS SHEPARD RPH

Provider Business Mailing Address
First Line	:	801 ROYAL PKWY
Second Line	:	SUITE 105
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3749
Country	:	US
Telephone Number	:	615-889-7664
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 ROYAL PKWY
Second Line	:	SUITE 105
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3749
Country	:	US
Telephone Number	:	615-889-7664
Fax Number	:

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

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	01/09/2012

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