Provider Demographics
NPI:1811245616
Name:SHELLEY, TERESA (RPH)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 HIGHWAY 17 S STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-5069
Mailing Address - Country:US
Mailing Address - Phone:843-272-7900
Mailing Address - Fax:843-272-5090
Practice Address - Street 1:3816 HIGHWAY 17 S STE 2
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-5069
Practice Address - Country:US
Practice Address - Phone:843-272-7900
Practice Address - Fax:843-272-5090
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist