Provider Demographics
NPI:1306126875
Name:SHEPARD, AMY DINH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:DINH
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3332
Mailing Address - Country:US
Mailing Address - Phone:559-791-0104
Mailing Address - Fax:
Practice Address - Street 1:416 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3332
Practice Address - Country:US
Practice Address - Phone:559-791-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64841183500000X
ORRPH-0012620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist