Provider Demographics
NPI:1982772166
Name:MILLARD, SHELLY SMITH (RPH)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:SMITH
Last Name:MILLARD
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 1:190 BIG COVE ROAD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8575
Mailing Address - Country:US
Mailing Address - Phone:828-667-5373
Mailing Address - Fax:
Practice Address - Street 1:863 BREVARD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2205
Practice Address - Country:US
Practice Address - Phone:828-667-4636
Practice Address - Fax:828-667-5148
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist