Provider Demographics
NPI:1679235105
Name:SHELTON, LAUREN ELLARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELLARD
Last Name:SHELTON
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 1:110 NEILL ESTATE LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9598
Mailing Address - Country:US
Mailing Address - Phone:478-718-1523
Mailing Address - Fax:
Practice Address - Street 1:631 BRAWLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6204
Practice Address - Country:US
Practice Address - Phone:704-660-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033073183500000X
NC30776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist