Provider Demographics
NPI:1699175802
Name:SHELBY, OLIVIA ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:ANN
Last Name:SHELBY
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 1:2701 LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6128
Mailing Address - Country:US
Mailing Address - Phone:318-388-4349
Mailing Address - Fax:
Practice Address - Street 1:2701 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6128
Practice Address - Country:US
Practice Address - Phone:318-388-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAT-15255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist