Healthcare Provider Details

I. General information

NPI: 1578166831
Provider Name (Legal Business Name): SHANNON CAUSAPIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MIRAMAR AVE
INDIALANTIC FL
32903-3120
US

IV. Provider business mailing address

100 N MIRAMAR AVE
INDIALANTIC FL
32903-3120
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-5634
  • Fax: 321-724-0875
Mailing address:
  • Phone: 321-724-5634
  • Fax: 321-724-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: