Provider Demographics
NPI:1326451386
Name:FORD, SHEVELLE GRIFFIN
Entity Type:Individual
Prefix:MRS
First Name:SHEVELLE
Middle Name:GRIFFIN
Last Name:FORD
Suffix:
Gender:F
Credentials:
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 80002
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-0002
Mailing Address - Country:US
Mailing Address - Phone:225-281-8166
Mailing Address - Fax:
Practice Address - Street 1:23980 FLENIKEN LN
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3068
Practice Address - Country:US
Practice Address - Phone:225-281-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist