Healthcare Provider Details

I. General information

NPI: 1750895843
Provider Name (Legal Business Name): CESSILY SHANNONHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7883 VILLAGE CTR N
SHERRILLS FORD NC
28673
US

IV. Provider business mailing address

107 MISTY MEADOWS CT
MOORESVILLE NC
28117-6416
US

V. Phone/Fax

Practice location:
  • Phone: 828-848-5015
  • Fax:
Mailing address:
  • Phone: 704-239-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27518
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: