Provider Demographics
NPI:1306199302
Name:COTTRELL, SHELLY RAE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:RAE
Last Name:COTTRELL
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 1:535 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4837
Mailing Address - Country:US
Mailing Address - Phone:406-250-4250
Mailing Address - Fax:
Practice Address - Street 1:2330 HWY. 93 N
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-758-2528
Practice Address - Fax:406-758-2525
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist