Provider Demographics
NPI:1548806359
Name:SHELL, TRACI STRICKLAND (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:STRICKLAND
Last Name:SHELL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N ARENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-2605
Mailing Address - Country:US
Mailing Address - Phone:919-269-7481
Mailing Address - Fax:919-269-9998
Practice Address - Street 1:303 N ARENDELL AVE
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2605
Practice Address - Country:US
Practice Address - Phone:919-269-7481
Practice Address - Fax:919-269-9998
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12142OtherBOARD OF PHARMACY
450101080950252OtherPTCB