Healthcare Provider Details

I. General information

NPI: 1396931184
Provider Name (Legal Business Name): SHANNON M WILEMAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR PHARMACY DEPT
SITKA AK
99835-9416
US

IV. Provider business mailing address

222 TONGASS DR PHARMACY DEPT
SITKA AK
99835-9416
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-2411
  • Fax: 907-966-8450
Mailing address:
  • Phone: 907-966-2411
  • Fax: 907-966-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1300
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: