Provider Demographics
NPI:1548568983
Name:SHIVELEY, RENEE LOUISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LOUISE
Last Name:SHIVELEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 E LYNN DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2917
Mailing Address - Country:US
Mailing Address - Phone:937-429-7763
Mailing Address - Fax:
Practice Address - Street 1:1492 E LYNN DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2917
Practice Address - Country:US
Practice Address - Phone:937-429-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031188711835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist