Provider Demographics
NPI:1588377105
Name:SHACKELFORD, CALVEN KREG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CALVEN
Middle Name:KREG
Last Name:SHACKELFORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 W 750 N
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3579
Mailing Address - Country:US
Mailing Address - Phone:307-679-5288
Mailing Address - Fax:
Practice Address - Street 1:25 N 2000 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-4111
Practice Address - Country:US
Practice Address - Phone:435-635-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8197454-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist