Provider Demographics
NPI:1982824850
Name:SHELY, WILLIAM WYATT (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WYATT
Last Name:SHELY
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 1:391 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8867
Mailing Address - Country:US
Mailing Address - Phone:606-784-8861
Mailing Address - Fax:606-783-1847
Practice Address - Street 1:425 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1077
Practice Address - Country:US
Practice Address - Phone:606-783-1511
Practice Address - Fax:606-783-1847
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist