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General NPI Number Information
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NPI Number | 1225324577
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Entity Type | Individual
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Provider Name | SHANNON G WHITAKER RPH
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Gender | Male
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 4031 POPPS FERRY RD #A
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City | DIBERVILLE
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State | MS
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Zip | 39540-2367
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Country | US
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Telephone | 228-392-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 6721 WASHINGTON AVE APT 7B
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-2144
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8370
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License Number State | MS
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