=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609232008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHYANNON MCFARLAND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2016
-----------------------------------------------------
Last Update Date | 01/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2401 W MAIN ST
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62959-1188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-997-5311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2115 RECTOR CREEK RD
-----------------------------------------------------
City | THOMPSONVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62890-1255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-647-2533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051294997
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------