Provider Demographics
NPI:1881638831
Name:SHELLEY, DAVID EARL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EARL
Last Name:SHELLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N DEW ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1215
Mailing Address - Country:US
Mailing Address - Phone:843-752-2117
Mailing Address - Fax:910-422-3752
Practice Address - Street 1:101 S BOND ST
Practice Address - Street 2:
Practice Address - City:ROWLAND
Practice Address - State:NC
Practice Address - Zip Code:28383-9639
Practice Address - Country:US
Practice Address - Phone:910-422-3774
Practice Address - Fax:910-422-3752
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist