Provider Demographics
NPI:1962735514
Name:SHEPPARD, MARK S (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 MOUNT HOLLY HUNTERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-8644
Mailing Address - Country:US
Mailing Address - Phone:704-399-5823
Mailing Address - Fax:704-399-7608
Practice Address - Street 1:3534 MOUNT HOLLY HUNTERSVILLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-8644
Practice Address - Country:US
Practice Address - Phone:704-399-5823
Practice Address - Fax:704-399-7608
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist