Provider Demographics
NPI:1720187313
Name:SHELTON, COLLEEN M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:SHELTON
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 1:37 WHITNEY PL
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2550
Mailing Address - Country:US
Mailing Address - Phone:716-668-8900
Mailing Address - Fax:
Practice Address - Street 1:6606 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6109
Practice Address - Country:US
Practice Address - Phone:716-438-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist