Provider Demographics
NPI:1043443674
Name:SHIELDS, MARK E (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:SHIELDS
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 1:520 S. 7TH STREET
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1038
Mailing Address - Country:US
Mailing Address - Phone:812-885-3348
Mailing Address - Fax:812-885-3087
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-885-3348
Practice Address - Fax:812-885-3087
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014396A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist