Provider Demographics
NPI:1588195374
Name:SHIPLEY, CAROL (PHARMD, BS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:PHARMD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 PERUQUE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4340
Mailing Address - Country:US
Mailing Address - Phone:217-855-0279
Mailing Address - Fax:
Practice Address - Street 1:809 PERUQUE VIEW CT
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4340
Practice Address - Country:US
Practice Address - Phone:217-855-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017004173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist