Healthcare Provider Details

I. General information

NPI: 1174297352
Provider Name (Legal Business Name): MARJORIE JADE SHAHAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SEA MOUNTAIN HWY
NORTH MYRTLE BEACH SC
29582-2216
US

IV. Provider business mailing address

2520 BRICK DR
LONGS SC
29568-8810
US

V. Phone/Fax

Practice location:
  • Phone: 843-361-3784
  • Fax: 843-361-3785
Mailing address:
  • Phone: 843-457-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43062
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: