Provider Demographics
NPI:1629664230
Name:FORBES, SHELLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:FORBES
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 1:8920 KENNARD RD
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-9605
Mailing Address - Country:US
Mailing Address - Phone:814-746-5036
Mailing Address - Fax:
Practice Address - Street 1:8920 KENNARD RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-9605
Practice Address - Country:US
Practice Address - Phone:814-746-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03331437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist