Individual
LARRY WAYNE SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS PHARMACY
Contact information
Practice address
5TH AND ROOSEVELT, 119, HINES, IL 60141
(708) 202-8387
Mailing address
5TH AND ROOSEVELT, HINES, IL 60141
(708) 202-8387
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
040875
MO
Other
Enumeration date
10/11/2006
Last updated
02/01/2024
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