Provider Demographics
NPI:1013517598
Name:RHINEHART, SHELLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:RHINEHART
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 W VAIL ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0205
Mailing Address - Country:US
Mailing Address - Phone:918-839-7350
Mailing Address - Fax:
Practice Address - Street 1:3116 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-1933
Practice Address - Country:US
Practice Address - Phone:918-622-7923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist