Provider Demographics
NPI:1235137951
Name:SHELLEY, STEPHANIE ANN (RPH, CGP, CACP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:RPH, CGP, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-0560
Mailing Address - Country:US
Mailing Address - Phone:509-238-4133
Mailing Address - Fax:509-238-4134
Practice Address - Street 1:46 E ROWAN AVENUE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-3105
Practice Address - Country:US
Practice Address - Phone:509-482-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA 31876183500000X
WA51930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist