Healthcare Provider Details

I. General information

NPI: 1235688961
Provider Name (Legal Business Name): FELECIA SHANKS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701B HOGUE AVE
ROCKMART GA
30153-1923
US

IV. Provider business mailing address

701B HOGUE AVE
ROCKMART GA
30153-1923
US

V. Phone/Fax

Practice location:
  • Phone: 770-684-7889
  • Fax: 770-684-1550
Mailing address:
  • Phone: 770-684-7889
  • Fax: 770-684-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH017661
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: