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General NPI Number Information
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NPI Number | 1265297469
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Entity Type | Individual
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Provider Name | SHKENDIJE SHABANI
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Gender | Female
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 7936 GA HIGHWAY 21
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-9720
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Country | US
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Telephone | 912-966-5895
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Fax |
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Provider Business Mailing Address
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Address Line | 321 MOHEGAN AVE APT 9203
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City | BLUFFTON
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State | SC
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Zip | 29910-6355
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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 | RPH034248
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License Number State | GA
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