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NPI Code Detail

MEDICARE: DELISA SHEPHARD

MEDICARE: DELISA SHEPHARD
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
1183500000XPharmacist26025579AIN

General Provider Information

NPI Number : 1932704897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELISA SHEPHARD
Provider Business Mailing Address
First Line : 14528 BROOKFIELD DR
Second Line :
City : FISHERS
State : IN
Zip : 46040-9403
Country : US
Telephone Number : 317-997-8184
Fax Number :
Provider Business Practice Location Address
First Line : 1030 N ARLINGTON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-3261
Country : US
Telephone Number : 317-997-8184
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2020
Last Update Date : 11/30/2020

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Directions to “ DELISA SHEPHARD ” Practice Location

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