Provider Demographics
NPI:1275118754
Name:WILSON, SHELBY N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:N
Last Name:WILSON
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 1:815 FRISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3322
Mailing Address - Country:US
Mailing Address - Phone:580-323-1244
Mailing Address - Fax:580-323-0455
Practice Address - Street 1:815 FRISCO AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3322
Practice Address - Country:US
Practice Address - Phone:580-323-1244
Practice Address - Fax:580-323-0455
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist