Provider Demographics
NPI:1477144665
Name:PRIBBERNOW, SHELBY ANN
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN
Last Name:PRIBBERNOW
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 1:105 S BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-3201
Mailing Address - Country:US
Mailing Address - Phone:512-715-0701
Mailing Address - Fax:
Practice Address - Street 1:105 S BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-3201
Practice Address - Country:US
Practice Address - Phone:512-715-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206967183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician