Provider Demographics
NPI:1689983769
Name:ALBERT, SHELLEY SOUSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:SOUSA
Last Name:ALBERT
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 1:760 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9559
Mailing Address - Country:US
Mailing Address - Phone:831-659-1210
Mailing Address - Fax:
Practice Address - Street 1:133 15TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2746
Practice Address - Country:US
Practice Address - Phone:831-373-1225
Practice Address - Fax:831-373-3705
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist