Provider Demographics
NPI:1760697718
Name:MCBRIDE, SHELTON EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:SHELTON
Middle Name:EDWARD
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 TREE MANOR LN
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1205
Mailing Address - Country:US
Mailing Address - Phone:832-725-7201
Mailing Address - Fax:
Practice Address - Street 1:3710 TREE MANOR LN
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-1205
Practice Address - Country:US
Practice Address - Phone:832-725-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11716183500000X
LA9956183500000X
DEA1-0002334183500000X
MEPR4228183500000X
MD12251183500000X
MA22267183500000X
MST-07950183500000X
MO042837183500000X
NHR1326183500000X
OH03-2-18218183500000X
PARP036451R183500000X
TX31390183500000X
WAPH00017160183500000X
IL183500000X
VT183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist