Provider Demographics
NPI:1497832836
Name:SHELTON, DEBRA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:SHELTON
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 1:2033 MANTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3495
Mailing Address - Country:US
Mailing Address - Phone:734-844-1464
Mailing Address - Fax:
Practice Address - Street 1:24555 HAIG ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3322
Practice Address - Country:US
Practice Address - Phone:313-292-6260
Practice Address - Fax:313-291-3465
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist