Provider Demographics
NPI:1851873202
Name:SPATES, SHELIA P
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:P
Last Name:SPATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11946 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-966-6987
Mailing Address - Fax:865-675-1229
Practice Address - Street 1:11946 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934
Practice Address - Country:US
Practice Address - Phone:865-966-6987
Practice Address - Fax:865-675-1229
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist