Provider Demographics
NPI:1609160787
Name:RECORD, SHELLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:RECORD
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 1:4375 N CHOUTEAU TRFY
Mailing Address - Street 2:T-1388
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64117-1743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4375 N CHOUTEAU TRFY
Practice Address - Street 2:T-1388
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64117-1743
Practice Address - Country:US
Practice Address - Phone:816-452-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010032103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist