Provider Demographics
NPI:1639389331
Name:LEPUCKI, SHELLIE LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:LOUISE
Last Name:LEPUCKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 RUTGERS ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5757
Mailing Address - Country:US
Mailing Address - Phone:330-966-0619
Mailing Address - Fax:
Practice Address - Street 1:7138 FULTON DRIVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-834-3400
Practice Address - Fax:330-834-3403
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-13162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist