Provider Demographics
NPI:1174608962
Name:ALEXANDER, SHELLIE R (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHELLIE
Middle Name:R
Last Name:ALEXANDER
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 1:6274 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-8919
Mailing Address - Country:US
Mailing Address - Phone:616-335-2448
Mailing Address - Fax:
Practice Address - Street 1:211 E MAIN ST M-89
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408
Practice Address - Country:US
Practice Address - Phone:269-561-4411
Practice Address - Fax:269-561-5474
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302410873OtherSTATE PHARMACIST LICENSE