MEDICARE: SHANNON G DICKEY R.PH.

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	D-7399	MS
2	183500000X	Pharmacist	13436	AL

General Provider Information

NPI Number	:	1700177938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON G DICKEY R.PH.

Provider Business Mailing Address
First Line	:	4010 BREEZY HILL LN
Second Line	:	4010 BREEZY HILL LN
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-8510
Country	:	US
Telephone Number	:	228-327-5254
Fax Number	:

Provider Business Practice Location Address
First Line	:	3082 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-4354
Country	:	US
Telephone Number	:	228-872-2646
Fax Number	:

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

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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