Provider Demographics
NPI:1538729884
Name:KUSTES, SHELLEY ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ELIZABETH
Last Name:KUSTES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:ELIZABETH
Other - Last Name:BRANDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1711 SOUTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5103
Mailing Address - Country:US
Mailing Address - Phone:270-625-6922
Mailing Address - Fax:
Practice Address - Street 1:13410 EASTPOINT CENTRE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4160
Practice Address - Country:US
Practice Address - Phone:877-662-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist