Provider Demographics
NPI:1700309853
Name:ROBERTS, SHELLEY DIANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:DIANE
Last Name:ROBERTS
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 1:3121 ALTHORP WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2423
Mailing Address - Country:US
Mailing Address - Phone:859-227-0707
Mailing Address - Fax:
Practice Address - Street 1:2304 SIR BARTON WAY STE 195
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2284
Practice Address - Country:US
Practice Address - Phone:859-263-1382
Practice Address - Fax:859-263-1684
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist