MEDICARE: DR. ETHAN STANLEY SHELL PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302417371	MI

General Provider Information

NPI Number	:	1528921830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHAN STANLEY SHELL PHARMD

Provider Business Mailing Address
First Line	:	704 W SPANIEL DR
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-7945
Country	:	US
Telephone Number	:	734-945-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 MCAULEY DR
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1051
Country	:	US
Telephone Number	:	734-945-5880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “ DR. ETHAN STANLEY SHELL PHARMD” Practice Location

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