Provider Demographics
NPI:1679187660
Name:BOTELLO, SHELBY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:BOTELLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10721 W RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-2920
Mailing Address - Country:US
Mailing Address - Phone:602-295-8398
Mailing Address - Fax:
Practice Address - Street 1:995 S COTTON LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4604
Practice Address - Country:US
Practice Address - Phone:480-627-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist