Provider Demographics
NPI:1851607378
Name:SHELTON, MITCHELL SCOTT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:SCOTT
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CONTOUR DR APT 611
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1265
Mailing Address - Country:US
Mailing Address - Phone:806-239-2752
Mailing Address - Fax:
Practice Address - Street 1:18140 SAN PEDRO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1421
Practice Address - Country:US
Practice Address - Phone:210-490-5593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist