Provider Demographics
NPI:1831497841
Name:SHELBY, JERRY ANTHONY III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ANTHONY
Last Name:SHELBY
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4361 HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29626
Mailing Address - Country:US
Mailing Address - Phone:864-224-8433
Mailing Address - Fax:864-224-3958
Practice Address - Street 1:4361 HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29626-5214
Practice Address - Country:US
Practice Address - Phone:864-224-8433
Practice Address - Fax:864-224-3958
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1467617258OtherWALGREENS PHARMACY