Healthcare Provider Details

I. General information

NPI: 1043801541
Provider Name (Legal Business Name): SHELBY WHITE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13841 HIGHWAY 59 STE C
SPLENDORA TX
77372-5448
US

IV. Provider business mailing address

11100 FM 1960 APT 1427
HUFFMAN TX
77336-4546
US

V. Phone/Fax

Practice location:
  • Phone: 281-689-7700
  • Fax: 281-689-7701
Mailing address:
  • Phone: 832-233-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number235056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: