Provider Demographics
NPI:1043430424
Name:SHELTON, MARYE THOMPSON (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:MARYE
Middle Name:THOMPSON
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2719
Mailing Address - Country:US
Mailing Address - Phone:954-327-6013
Mailing Address - Fax:954-321-3763
Practice Address - Street 1:4100 S HOSPITAL DR
Practice Address - Street 2:SUITE 309
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2813
Practice Address - Country:US
Practice Address - Phone:954-327-6013
Practice Address - Fax:954-321-3763
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist