Shelby Brockman
Individual provider Active NPI Pharmacist · Safford, AZ
NPI 1104309749 · NPPES record last updated Sep 10, 2018
Key facts
- NPI
- 1104309749
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- S023533 (AZ)
- Practice address
- 755 S 20TH Ave
Safford, AZ 85546-3322 - Phone
- (575) 643-5426
- NPI assigned
- Sep 10, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S023533 | AZ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S023533 | AZ | Yes |
Addresses
Primary practice location
755 S 20TH Ave
Safford, AZ 85546-3322
Mailing address
PO Box 242
Clifton, AZ 85533-0242
Other providers in Safford, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.