Provider Demographics
NPI:1447764428
Name:PETHTEL, SHELBY (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:
Last Name:PETHTEL
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 1:1175 PARR HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW MATAMORAS
Mailing Address - State:OH
Mailing Address - Zip Code:45767-6307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1045 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2441
Practice Address - Country:US
Practice Address - Phone:740-432-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist