Provider Demographics
NPI:1205369907
Name:REDMON, SHELLEY (RPH)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:REDMON
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 1:1930 DOWLING ST
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-9436
Mailing Address - Country:US
Mailing Address - Phone:260-582-2151
Mailing Address - Fax:260-544-3369
Practice Address - Street 1:1930 DOWLING ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-9436
Practice Address - Country:US
Practice Address - Phone:260-582-2151
Practice Address - Fax:260-544-3369
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021887A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist