MEDICARE: SHANNIE EUBANKS CPHT

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	183700000X	Pharmacy Technician	TCH14914	CA

General Provider Information

NPI Number	:	1235624586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNIE EUBANKS CPHT

Provider Business Mailing Address
First Line	:	1036 OAK GROVE RD APT 63
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-3240
Country	:	US
Telephone Number	:	925-457-7657
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 OAK GROVE RD APT 63
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-3240
Country	:	US
Telephone Number	:	925-457-7657
Fax Number	:

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

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	06/28/2018

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