Shelley Renee Illingworth, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

PR4777 Issued in ME

Practice address

2402 Route 2 Unit 1
Hermon, ME 04401-0665

Phone

(207) 848-2020

NPI assigned

Apr 5, 2011

Last updated

Jan 28, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453939200000",
    "number": "1265721773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 CENTRAL ST",
            "city": "MILLINOCKET",
            "state": "ME",
            "postal_code": "044621800",
            "telephone_number": "207-723-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 ROUTE 2 UNIT 1",
            "city": "HERMON",
            "state": "ME",
            "postal_code": "044010665",
            "telephone_number": "207-848-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLINGWORTH",
        "first_name": "SHELLEY",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-05",
        "last_updated": "2016-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ME",
            "license": "PR4777",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "PH23998",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI#",
            "identifier": "1265721773",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rebecca Rose Hollins, PHARMD
• Lauren Jellison, NP
• Nancy A Jewett, LCPC-C
• John C. Hersey OD, PC
• Kendra Elaine Johnston, MS, OTR/L
• Sarah E Johnston

• Pharmacist in Hermon, ME
• Providers in Hermon, ME by specialty
• Pharmacist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.