Provider Demographics
NPI:1851944433
Name:PADDOCK, SHIRLEY LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LOUISE
Last Name:PADDOCK
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 1:11761 DARSLEY DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8281
Mailing Address - Country:US
Mailing Address - Phone:317-332-4265
Mailing Address - Fax:
Practice Address - Street 1:2800 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1103
Practice Address - Country:US
Practice Address - Phone:888-607-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016991A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist