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General NPI Number Information
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NPI Number | 1649153461
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Entity Type | Individual
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Provider Name | SHANTAVIA EDMONDS-HART
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1800 MARTIN LUTHER KING JR BLVD
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City | CHAPEL HILL
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State | NC
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Zip | 27514-7415
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Country | US
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Telephone | 919-968-1293
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 32
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City | ROWESVILLE
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State | SC
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Zip | 29133-0032
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Country | US
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Telephone | 803-837-0527
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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 | 34007
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License Number State | NC
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