Provider Demographics
NPI:1558642140
Name:HEAPE, SHELLY RAFF (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:RAFF
Last Name:HEAPE
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 1:13932 SUNDELEAF DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2039
Mailing Address - Country:US
Mailing Address - Phone:847-913-0873
Mailing Address - Fax:
Practice Address - Street 1:13939 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4838
Practice Address - Country:US
Practice Address - Phone:503-670-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist