Healthcare Provider Details

I. General information

NPI: 1578916664
Provider Name (Legal Business Name): SAM SHELL PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PATTERSON WAY
SITKA AK
99835-9513
US

IV. Provider business mailing address

141 PATTERSON WAY
SITKA AK
99835-9513
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8900
  • Fax:
Mailing address:
  • Phone: 907-966-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14722
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: