Healthcare Provider Details

I. General information

NPI: 1538729884
Provider Name (Legal Business Name): SHELLEY ELIZABETH KUSTES PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY ELIZABETH BRANDON PHARM.D.

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13410 EASTPOINT CENTRE DR
LOUISVILLE KY
40223-4160
US

IV. Provider business mailing address

1711 SOUTHLAKE DR
LOUISVILLE KY
40223-5103
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax:
Mailing address:
  • Phone: 270-625-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number018033
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: