Healthcare Provider Details

I. General information

NPI: 1407782295
Provider Name (Legal Business Name): KELLY SHEA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 140TH ST
URBANDALE IA
50323-2136
US

IV. Provider business mailing address

2908 140TH ST
URBANDALE IA
50323-2136
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6355
  • Fax:
Mailing address:
  • Phone: 515-241-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number21111
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: