Provider Demographics
NPI:1003188608
Name:SHELTON, WILLIAM R (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 W DICKENS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7514
Mailing Address - Country:US
Mailing Address - Phone:813-837-3543
Mailing Address - Fax:
Practice Address - Street 1:4319 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6427
Practice Address - Country:US
Practice Address - Phone:813-874-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist