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General NPI Number Information
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NPI Number | 1902124407
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Entity Type | Individual
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Provider Name | SHANNON LEIGH MAISANO RPH
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Gender | Female
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 05/07/2010
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Provider Practice Location Address
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Address Line | 63303 VAN DYKE RD
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City | WASHINGTON
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State | MI
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Zip | 48095-2574
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Country | US
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Telephone | 586-781-8905
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Fax | 589-781-8971
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Provider Business Mailing Address
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Address Line | 15972 MYRTLE DR
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City | MACOMB
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State | MI
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Zip | 48042-2208
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Country | US
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Telephone | 586-781-6045
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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 | 5302030383
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License Number State | MI
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