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General NPI Number Information
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NPI Number | 1205137361
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Entity Type | Individual
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Provider Name | ELIZABETH JEAN SHIVELY R.PH.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 1375 CY AVE
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City | CASPER
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State | WY
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Zip | 82604-3513
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Country | US
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Telephone | 307-234-7949
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Fax | 307-234-0393
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Provider Business Mailing Address
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Address Line | 3931 CYNTHIA DR
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City | CASPER
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State | WY
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Zip | 82609-2399
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Country | US
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Telephone | 307-277-5700
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Fax | 307-234-0393
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2206
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License Number State | WY
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