Healthcare Provider Details

I. General information

NPI: 1851535298
Provider Name (Legal Business Name): DAVID (DEKE) KNIGHT SHELTON III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

3981 ONEILL DR
SAN MATEO CA
94403-3637
US

V. Phone/Fax

Practice location:
  • Phone: 415-215-2975
  • Fax:
Mailing address:
  • Phone: 415-215-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number60344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: