Healthcare Provider Details

I. General information

NPI: 1720903172
Provider Name (Legal Business Name): SHELBY SMART
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5778 DARROW RD STE 201
HUDSON OH
44236-3808
US

IV. Provider business mailing address

32400 MONROE CT APT 101
SOLON OH
44139-5747
US

V. Phone/Fax

Practice location:
  • Phone: 330-655-2161
  • Fax:
Mailing address:
  • Phone: 740-616-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03447092
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: