Provider Demographics
NPI:1275977720
Name:SHELTON, JEFFREY DALE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DALE
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2004
Mailing Address - Country:US
Mailing Address - Phone:510-893-4265
Mailing Address - Fax:510-893-4429
Practice Address - Street 1:1400 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2004
Practice Address - Country:US
Practice Address - Phone:510-893-4265
Practice Address - Fax:510-893-4429
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist