Provider Demographics
NPI:1508404815
Name:BULACH, SHELLI ANN
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:ANN
Last Name:BULACH
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 1:29112 TRACKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-9546
Mailing Address - Country:US
Mailing Address - Phone:812-576-0077
Mailing Address - Fax:
Practice Address - Street 1:1034 SR 229 NORTH
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006
Practice Address - Country:US
Practice Address - Phone:812-933-6220
Practice Address - Fax:812-933-6255
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021691A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist