Provider Demographics
NPI:1063109718
Name:DARDEN, SHELITHEA (CPHT)
Entity type:Individual
Prefix:
First Name:SHELITHEA
Middle Name:
Last Name:DARDEN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 LIPFORD AVE
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-9121
Mailing Address - Country:US
Mailing Address - Phone:662-871-3531
Mailing Address - Fax:
Practice Address - Street 1:7122 WILL ROBBINS HWY
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858-5918
Practice Address - Country:US
Practice Address - Phone:662-591-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician