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General NPI Number Information
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NPI Number | 1265188577
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Entity Type | Individual
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Provider Name | SHELBY TICE
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Gender | Female
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 3090 W OAKLAND PARK BLVD
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City | OAKLAND PARK
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State | FL
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Zip | 33311-1228
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Country | US
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Telephone | 954-717-1848
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Fax |
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Provider Business Mailing Address
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Address Line | 746 NE 16TH TER
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2967
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Country | US
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Telephone |
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Fax |
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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 | PS63363
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License Number State | FL
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