Healthcare Provider Details

I. General information

NPI: 1780065110
Provider Name (Legal Business Name): SHAKIRA S CHAVIS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 08/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVE
MOUNT HOLLY NJ
08060-2038
US

IV. Provider business mailing address

3338 RICHLIEU RD APT K-150
BENSALEM PA
19020-1549
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6000
  • Fax:
Mailing address:
  • Phone: 267-987-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03718500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: