Provider Demographics
NPI:1548976624
Name:LAPORTE, SHELLEY RENEE (RPH)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:LAPORTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:RENEE
Other - Last Name:SCHRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:212 SAND PEBBLE DR SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9537
Mailing Address - Country:US
Mailing Address - Phone:704-231-6368
Mailing Address - Fax:
Practice Address - Street 1:6861 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-9724
Practice Address - Country:US
Practice Address - Phone:910-793-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist