Provider Demographics
NPI:1043580558
Name:SHIELDS, GAYLE (RPH)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23425 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8062
Mailing Address - Country:US
Mailing Address - Phone:530-268-2016
Mailing Address - Fax:
Practice Address - Street 1:1153 BUTTE HOUSE RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3102
Practice Address - Country:US
Practice Address - Phone:916-379-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57132183500000X
NV17066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist