Healthcare Provider Details

I. General information

NPI: 1487007670
Provider Name (Legal Business Name): SHELLY BRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 CROSS LANES DR
CROSS LANES WV
25313-1315
US

IV. Provider business mailing address

932 CROSS LANES DR
CROSS LANES WV
25313-1315
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-3276
  • Fax:
Mailing address:
  • Phone: 304-776-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0009756
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: