Healthcare Provider Details

I. General information

NPI: 1619563731
Provider Name (Legal Business Name): SHANNON FLYNN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2020
Last Update Date: 12/13/2020
Certification Date: 12/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15310 N ORACLE RD
TUCSON AZ
85739-9426
US

IV. Provider business mailing address

315 E LINDEN ST
TUCSON AZ
85705-8931
US

V. Phone/Fax

Practice location:
  • Phone: 520-575-7301
  • Fax:
Mailing address:
  • Phone: 520-427-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024121
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: