Provider Demographics
NPI:1154795557
Name:SHOULDERS, JD LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:JD
Middle Name:LEE
Last Name:SHOULDERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 NEPTUNE WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-0210
Mailing Address - Country:US
Mailing Address - Phone:270-991-4696
Mailing Address - Fax:270-786-5615
Practice Address - Street 1:394 N DIXIE ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1138
Practice Address - Country:US
Practice Address - Phone:270-786-1147
Practice Address - Fax:270-786-5615
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist