Provider Demographics
NPI:1316627425
Name:SHEPOVALOVA, SVETLANA (PHARMD)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:SHEPOVALOVA
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 1:460 N CIVIC DR APT 104
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3345
Mailing Address - Country:US
Mailing Address - Phone:925-278-8868
Mailing Address - Fax:
Practice Address - Street 1:3848 CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4599
Practice Address - Country:US
Practice Address - Phone:510-886-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH88044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist