=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801676481
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON CAROL BARBOUR PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2023
-----------------------------------------------------
Last Update Date | 10/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4841 GROVE BARTON RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27613-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-785-0335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5212 CRAFTSMAN RIDGE DR
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28104-6761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-308-6139
-----------------------------------------------------
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 | 32636
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------