Provider Demographics
NPI:1215285556
Name:SHELLEY, CRAIG WILLIAM (PHARMACIST)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:WILLIAM
Last Name:SHELLEY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SLEATER KINNEY RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1150
Mailing Address - Country:US
Mailing Address - Phone:360-438-6483
Mailing Address - Fax:360-438-6477
Practice Address - Street 1:700 SLEATER KINNEY RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1150
Practice Address - Country:US
Practice Address - Phone:360-438-6483
Practice Address - Fax:360-438-6477
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist