Provider Demographics
NPI:1104100874
Name:SHEPHERD, CRISTY L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CRISTY
Middle Name:L
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 KENNERLY RD FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2106
Mailing Address - Country:US
Mailing Address - Phone:314-525-1633
Mailing Address - Fax:314-525-1634
Practice Address - Street 1:10010 KENNERLY RD FL 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-1633
Practice Address - Fax:314-525-1634
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010026514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist