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General NPI Number Information
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NPI Number | 1285845214
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Entity Type | Organization
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Legal Business Name | SHANNON MEDICAL CENTER
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 120 E HARRIS AVE STE 410
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City | SAN ANGELO
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State | TX
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Zip | 76903-5904
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Country | US
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Telephone | 325-747-5389
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Fax | 325-481-8708
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Provider Business Mailing Address
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Address Line | 2030 PULLIAM ST STE 16
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City | SAN ANGELO
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State | TX
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Zip | 76905-5170
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Country | US
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Telephone | 325-481-6403
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Fax | 325-481-8708
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Authorized Official
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Title or Position | DIRECTOR-OUTPATIENT PHARMACY SERVIC
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Name | CARLOS ROBLEDO
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Credential | PHARMD
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Telephone | 325-374-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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