Provider Demographics
NPI:1104465608
Name:TAYLOR, SHELBY ANN VESSELL (PHARMD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN VESSELL
Last Name:TAYLOR
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 1:5090 MOUNT ELLEN CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7575
Mailing Address - Country:US
Mailing Address - Phone:573-462-0481
Mailing Address - Fax:
Practice Address - Street 1:9070 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4246
Practice Address - Country:US
Practice Address - Phone:314-733-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016027732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist