Provider Demographics
NPI:1770618761
Name:SHEPP, CARL RICHARD SR (RPH)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:RICHARD
Last Name:SHEPP
Suffix:SR
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 1:1918 EDGE STONE ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1220
Mailing Address - Country:US
Mailing Address - Phone:406-652-1816
Mailing Address - Fax:406-652-1816
Practice Address - Street 1:1918 EDGE STONE ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-1220
Practice Address - Country:US
Practice Address - Phone:406-652-1816
Practice Address - Fax:406-652-1816
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist