MEDICARE: SHANNON HATZELL

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	18613	MT

General Provider Information

NPI Number	:	1558786954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON HATZELL

Provider Business Mailing Address
First Line	:	4420 KING AVE E
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-4913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 KING AVE E
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-4913
Country	:	US
Telephone Number	:	406-256-0177
Fax Number	:

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

Provider Enumeration Date	:	02/22/2014
Last Update Date	:	02/22/2014

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Directions to “ SHANNON HATZELL ” Practice Location

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