Provider Demographics
NPI:1750041083
Name:SHELTON, ALEKSANDER DOUGLAS (CPHT)
Entity Type:Individual
Prefix:
First Name:ALEKSANDER
Middle Name:DOUGLAS
Last Name:SHELTON
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 EDEN ST
Mailing Address - Street 2:
Mailing Address - City:BOURBON
Mailing Address - State:MO
Mailing Address - Zip Code:65441-8119
Mailing Address - Country:US
Mailing Address - Phone:573-205-0020
Mailing Address - Fax:
Practice Address - Street 1:200 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1705
Practice Address - Country:US
Practice Address - Phone:573-885-7212
Practice Address - Fax:573-885-6798
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013044476183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician