Provider Demographics
NPI:1053698555
Name:WATKINS, SHELTON B (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SHELTON
Middle Name:B
Last Name:WATKINS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1925
Mailing Address - Country:US
Mailing Address - Phone:414-545-1440
Mailing Address - Fax:414-545-0896
Practice Address - Street 1:2677 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1925
Practice Address - Country:US
Practice Address - Phone:414-545-1440
Practice Address - Fax:414-545-0896
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13263-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist