Provider Demographics
NPI:1306946074
Name:SHELTON, JONATHAN P (RPH)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:P
Last Name:SHELTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3133
Mailing Address - Country:US
Mailing Address - Phone:937-294-2514
Mailing Address - Fax:937-253-8662
Practice Address - Street 1:1613 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-3133
Practice Address - Country:US
Practice Address - Phone:937-294-2514
Practice Address - Fax:937-253-8662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist