Provider Demographics
NPI:1740605732
Name:SHELTON, TOM REESE JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:REESE
Last Name:SHELTON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:102 RACOVE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7349
Mailing Address - Country:US
Mailing Address - Phone:318-396-3157
Mailing Address - Fax:318-396-3157
Practice Address - Street 1:102 RACOVE DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7349
Practice Address - Country:US
Practice Address - Phone:318-396-3157
Practice Address - Fax:318-396-3157
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA10990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist