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General NPI Number Information
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NPI Number | 1609258250
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Entity Type | Individual
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Provider Name | DR. SHANNON PHILLIPS
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 840 GLYNN ST S
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2031
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Country | US
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Telephone | 678-817-5420
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Fax |
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Provider Business Mailing Address
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Address Line | 120 LAKEMONT DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-2312
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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 | RPH026968
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License Number State | GA
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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 | PS 49594
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH 026968
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License Number State | GA
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