Provider Demographics
NPI:1790068724
Name:SHELKE, MADHURI (RPH)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:SHELKE
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 1:5201 SLOAN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-4616
Mailing Address - Country:US
Mailing Address - Phone:608-354-3307
Mailing Address - Fax:
Practice Address - Street 1:1722 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3324
Practice Address - Country:US
Practice Address - Phone:479-246-0196
Practice Address - Fax:479-246-0203
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD10799OtherARKANSAS STATE PHARMACIST LICENSE NUMBER