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General NPI Number Information
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NPI Number | 1063137347
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Entity Type | Individual
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Provider Name | SHANNON GILZENE
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Gender | Female
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 1029 S M 37
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City | TRAVERSE CITY
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State | MI
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Zip | 49685-8508
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Country | US
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Telephone | 231-943-3147
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Fax |
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Provider Business Mailing Address
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Address Line | 9401 E 18 1/2 RD
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City | MANTON
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State | MI
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Zip | 49663-7501
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Country | US
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Telephone |
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5303043858
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License Number State | MI
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