Active NPI
Shane Kelvin Berthelot, RPH
- Pharmacist
- Weslaco, TX
National Provider Identifier
1609093293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12062
- Practice address
- 1010 S Airport Dr Ste C
Weslaco, TX 78596-6600 - Phone
- (803) 378-4500
- Fax
- (803) 378-4500
- NPI assigned
- Apr 18, 2007
- Sex
- Male
- 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 | 12062 | SC | Primary |
Addresses
Primary practice location
1010 S Airport Dr Ste C
Weslaco, TX 78596-6600
Mailing address
3418 Main Hwy
#11569 Rite Aid
Bamberg, SC 29003-2135
Phone (803) 378-4500
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 |
|---|---|---|---|
| 12062 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1609093293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3418 MAIN HWY",
"address_2": "#11569 RITE AID",
"city": "BAMBERG",
"state": "SC",
"postal_code": "290032135",
"telephone_number": "803-378-4500",
"fax_number": "803-378-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 S AIRPORT DR STE C",
"city": "WESLACO",
"state": "TX",
"postal_code": "785966600",
"telephone_number": "803-378-4500",
"fax_number": "803-378-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTHELOT",
"first_name": "SHANE",
"middle_name": "KELVIN",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-18",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "12062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Weslaco, TX
- Ruby Benitez-Mireles, OTR
- Daisy Anne Benitez, OTD, OTR
- Maricela Benitez, ASST. SLP
- Karl Coblenz Bentley, M.D.
- Eddy Enmanuel Berges Chez, M.D.
- Besos Y Caricias Adult Day Care, LLC
- Besos Y Caricias Adult Day Care, LLC
- Isela Yadira Betancourt
- Olivia Jacqueline Betancourt
- Payal Jitendra Bhakta Bhakta, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.