Provider Demographics
NPI:1841265444
Name:GINGERY, SHALEE NICOLE (PHARMD, RPH)
Entity type:Individual
Prefix:MRS
First Name:SHALEE
Middle Name:NICOLE
Last Name:GINGERY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 S SARGENT AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-2253
Mailing Address - Country:US
Mailing Address - Phone:406-377-5944
Mailing Address - Fax:
Practice Address - Street 1:816 S SARGENT AVE APT 3
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-2253
Practice Address - Country:US
Practice Address - Phone:406-377-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00050621183500000X
MT4972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist