Provider Demographics
NPI:1790527190
Name:BINGHAM, SHELLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BINGHAM
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 1:2231 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7826
Mailing Address - Country:US
Mailing Address - Phone:214-590-4593
Mailing Address - Fax:214-590-6842
Practice Address - Street 1:2231 BUTLER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7826
Practice Address - Country:US
Practice Address - Phone:214-590-4593
Practice Address - Fax:214-590-6842
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX387641835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care