Provider Demographics
NPI:1548230774
Name:EILO, SHELLY IRENE
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:IRENE
Last Name:EILO
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 1:15923 HWY 99
Mailing Address - Street 2:APT B-209
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-1454
Mailing Address - Country:US
Mailing Address - Phone:425-742-4854
Mailing Address - Fax:
Practice Address - Street 1:14130 JUANITA DR NE
Practice Address - Street 2:SUITE #107
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-4927
Practice Address - Country:US
Practice Address - Phone:425-821-6275
Practice Address - Fax:425-820-2477
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00042844183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician