Healthcare Provider Details

I. General information

NPI: 1730177247
Provider Name (Legal Business Name): SHELLEY LYNN CHAMBERS FOX PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 S MAIN ST
MOSCOW ID
83843-3041
US

IV. Provider business mailing address

203 N WASHINGTON ST STE 300
SPOKANE WA
99201-0233
US

V. Phone/Fax

Practice location:
  • Phone: 208-848-8300
  • Fax: 208-882-5587
Mailing address:
  • Phone: 509-444-8888
  • Fax: 509-444-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00011359
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5083
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: