Provider Demographics
NPI:1932400249
Name:BANKS, SHELLIE (RPH)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:BANKS
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 1:610 E WINE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-1062
Mailing Address - Country:US
Mailing Address - Phone:509-882-1060
Mailing Address - Fax:509-882-4763
Practice Address - Street 1:610 E WINE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1062
Practice Address - Country:US
Practice Address - Phone:509-882-1060
Practice Address - Fax:509-882-4763
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00018303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist