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General NPI Number Information
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NPI Number | 1689906893
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Entity Type | Individual
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Provider Name | SHANNON NICHOLS HOUSE RPH
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Gender | Female
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1110 MITT LARY RD
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City | NORTHPORT
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State | AL
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Zip | 35475-4978
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Country | US
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Telephone | 205-409-9777
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Fax | 205-409-9778
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Provider Business Mailing Address
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Address Line | 13832 GLENVIEW DR
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City | NORTHPORT
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State | AL
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Zip | 35475-4976
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Country | US
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Telephone | 205-409-9777
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Fax | 205-409-9778
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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 | 12934
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License Number State | AL
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