Provider Demographics
NPI:1083244560
Name:NALL, SHELLEY ELANE (PHARMD, LDE)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ELANE
Last Name:NALL
Suffix:
Gender:F
Credentials:PHARMD, LDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E BRANNON RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8059
Mailing Address - Country:US
Mailing Address - Phone:859-971-4303
Mailing Address - Fax:859-971-4309
Practice Address - Street 1:200 E BRANNON RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8059
Practice Address - Country:US
Practice Address - Phone:859-971-4303
Practice Address - Fax:859-971-4309
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0199321835P0018X
KY0121651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist