Healthcare Provider Details

I. General information

NPI: 1841583382
Provider Name (Legal Business Name): SHELLANE DIMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 OLIVE DR
BAKERSFIELD CA
93312-5840
US

IV. Provider business mailing address

11200 OLIVE DR
BAKERSFIELD CA
93312-5840
US

V. Phone/Fax

Practice location:
  • Phone: 661-588-0010
  • Fax:
Mailing address:
  • Phone: 661-588-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: