Healthcare Provider Details

I. General information

NPI: 1285255687
Provider Name (Legal Business Name): SHANNON SLATE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON DANIELL PHARMD

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W MAPLEWOOD LN
NASHVILLE TN
37207-2981
US

IV. Provider business mailing address

137 DEVONSHIRE TRL
HENDERSONVILLE TN
37075-5810
US

V. Phone/Fax

Practice location:
  • Phone: 615-277-5900
  • Fax: 615-367-1808
Mailing address:
  • Phone: 615-822-1123
  • Fax: 615-367-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberRPH021682
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number13212
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: