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General NPI Number Information
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NPI Number | 1700160694
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Entity Type | Individual
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Provider Name | KIMBERLY EVETTE SHANNON RPH
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2817 2ND STREET EAST
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City | BRADENTON
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State | FL
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Zip | 34208
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Country | US
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Telephone | 941-782-7024
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Fax | 833-374-2750
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Provider Business Mailing Address
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Address Line | 930 8TH AVE W
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City | PALMETTO
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State | FL
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Zip | 34221-4712
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Country | US
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Telephone | 941-729-5250
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Fax | 941-729-7899
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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 | PS30747
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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