Provider Demographics
NPI:1144315847
Name:GARDNER, SHELLY L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NORTH FIFTH STREET
Mailing Address - Street 2:(PHARMACY)
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-1480
Mailing Address - Country:US
Mailing Address - Phone:605-745-2000
Mailing Address - Fax:612-725-1330
Practice Address - Street 1:500 NORTH FIFTH STREET
Practice Address - Street 2:(PHARM)
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747
Practice Address - Country:US
Practice Address - Phone:605-745-2000
Practice Address - Fax:612-725-1330
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist