MEDICARE: SARA SHELLEY PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	61909	CA

General Provider Information

NPI Number	:	1134698343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA SHELLEY PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 1812
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95776-1812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 MAIN ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3405
Country	:	US
Telephone Number	:	530-662-2813
Fax Number	:	530-662-1031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	11/16/2018

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