Healthcare Provider Details

I. General information

NPI: 1356669527
Provider Name (Legal Business Name): SHANNON MATTOX HURST PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4679 CENTER POINT ROAD
PINSON AL
35126
US

IV. Provider business mailing address

1039 OAK MEADOWS ROAD
BIRMINGHAM AL
35242-3524
US

V. Phone/Fax

Practice location:
  • Phone: 206-680-2751
  • Fax: 205-680-6751
Mailing address:
  • Phone: 205-981-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14614
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: