Provider Demographics
NPI:1134734775
Name:TAU, SHELLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:TAU
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 1:200 POPLAR VIEW CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4401
Mailing Address - Country:US
Mailing Address - Phone:470-252-2795
Mailing Address - Fax:
Practice Address - Street 1:2744 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2218
Practice Address - Country:US
Practice Address - Phone:706-733-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist