Provider Demographics
NPI:1720126667
Name:SHIBLEY, EDWARD MARION JR (RPH, MBA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MARION
Last Name:SHIBLEY
Suffix:JR
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3961
Mailing Address - Country:US
Mailing Address - Phone:804-264-1319
Mailing Address - Fax:804-264-2133
Practice Address - Street 1:1717 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3961
Practice Address - Country:US
Practice Address - Phone:804-264-1319
Practice Address - Fax:804-264-2133
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist