Provider Demographics
NPI:1477041408
Name:SHELTON, BETH NICOLE (CPHT, RPHT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:NICOLE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CPHT, RPHT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:NICOLE SHELTON
Other - Last Name:ANTCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT, RPHT
Mailing Address - Street 1:6051 ROMA DR APT 810
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4674
Mailing Address - Country:US
Mailing Address - Phone:321-303-7892
Mailing Address - Fax:
Practice Address - Street 1:2106 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3317
Practice Address - Country:US
Practice Address - Phone:321-303-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT28245183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician