Provider Demographics
NPI:1720126394
Name:SHELTON, LARRY JACKSON (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JACKSON
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 1:2024 ASHEVILLE HWY STE H
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-2100
Mailing Address - Country:US
Mailing Address - Phone:828-692-1022
Mailing Address - Fax:828-698-1572
Practice Address - Street 1:2024 ASHEVILLE HWY STE H
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2100
Practice Address - Country:US
Practice Address - Phone:828-692-1022
Practice Address - Fax:828-698-1572
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist