Provider Demographics
NPI:1497207815
Name:BATTS, SHELLY BINGHAM (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:BINGHAM
Last Name:BATTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 HINSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ULLA
Mailing Address - State:NC
Mailing Address - Zip Code:28125-7651
Mailing Address - Country:US
Mailing Address - Phone:704-326-5115
Mailing Address - Fax:
Practice Address - Street 1:314 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138
Practice Address - Country:US
Practice Address - Phone:704-279-2288
Practice Address - Fax:704-279-0881
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC805855Medicaid