Provider Demographics
NPI:1861945149
Name:RUTLEDGE, SHELLY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:RUTLEDGE
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 1:178 HIGHWAY 167 N
Mailing Address - Street 2:
Mailing Address - City:BALD KNOB
Mailing Address - State:AR
Mailing Address - Zip Code:72010-4058
Mailing Address - Country:US
Mailing Address - Phone:501-724-6207
Mailing Address - Fax:501-724-3305
Practice Address - Street 1:178 HIGHWAY 167 N
Practice Address - Street 2:
Practice Address - City:BALD KNOB
Practice Address - State:AR
Practice Address - Zip Code:72010-4058
Practice Address - Country:US
Practice Address - Phone:501-724-6207
Practice Address - Fax:501-724-3305
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist