MEDICARE: MARJORIE JADE SHAHAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	43062	SC

General Provider Information

NPI Number	:	1174297352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE JADE SHAHAN PHARMD

Provider Business Mailing Address
First Line	:	2520 BRICK DR
Second Line	:
City	:	LONGS
State	:	SC
Zip	:	29568-8810
Country	:	US
Telephone Number	:	843-457-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 SEA MOUNTAIN HWY
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2216
Country	:	US
Telephone Number	:	843-361-3784
Fax Number	:	843-361-3785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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