Healthcare Provider Details

I. General information

NPI: 1861973737
Provider Name (Legal Business Name): SHANNON DALE MASSINGALE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON DALE LITTLETON

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 NORTH MAIN STREET
SWEETWATER TN
37874
US

IV. Provider business mailing address

205 NORTH MAIN STREET
SWEETWATER TN
37874
US

V. Phone/Fax

Practice location:
  • Phone: 423-337-5813
  • Fax: 423-337-3907
Mailing address:
  • Phone: 423-337-5813
  • Fax: 423-337-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11637
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: