Active NPI
Shelly R Hetler, RPH
- Pharmacist
- Fort Wayne, IN
National Provider Identifier
1225674567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26018797
- Practice address
- 5725 Coventry LN
Fort Wayne, IN 46804-7146 - Phone
- (260) 432-2475
- Fax
- (260) 432-2494
- NPI assigned
- Nov 21, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26018797 | IN | Primary |
Addresses
Primary practice location
5725 Coventry LN
Fort Wayne, IN 46804-7146
Mailing address
14626 Flatrock Rd
Monroeville, IN 46773-9122
Phone (260) 580-5126
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26018797 | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574294400000",
"number": "1225674567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14626 FLATROCK RD",
"city": "MONROEVILLE",
"state": "IN",
"postal_code": "467739122",
"telephone_number": "260-580-5126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5725 COVENTRY LN",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468047146",
"telephone_number": "260-432-2475",
"fax_number": "260-432-2494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETLER",
"first_name": "SHELLY",
"middle_name": "R",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-21",
"last_updated": "2019-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26018797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.