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General NPI Number Information
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NPI Number | 1568827749
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Entity Type | Individual
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Provider Name | SHANNON K. GRAY RPH,CDE
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Gender | Female
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 1594 FREEDOM BLVD SUITE 102 B
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City | FLORENCE
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State | SC
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Zip | 29505-6046
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Country | US
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Telephone | 843-674-2700
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Fax | 843-674-2729
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Provider Business Mailing Address
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Address Line | 1594 FREEDOM BLVD SUITE 102 B
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City | FLORENCE
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State | SC
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Zip | 29505-6046
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Country | US
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Telephone | 843-674-2700
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Fax | 843-674-2729
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 21410166
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License Number State | SC
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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 | 9108
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License Number State | SC
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