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General NPI Number Information
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NPI Number | 1043647118
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Entity Type | Individual
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Provider Name | SHANNON GUILLEN RPH
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Gender | Female
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP
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City | FT BELVOIR
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State | VA
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Zip | 22060-5285
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Country | US
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Telephone | 571-231-2897
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Fax |
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Provider Business Mailing Address
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Address Line | 5614 DOOLITTLE ST
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City | BURKE
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State | VA
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Zip | 22015-2045
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Country | US
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Telephone | 719-659-5022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 027048
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 00005041
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17595
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License Number State | AL
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