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General NPI Number Information
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NPI Number | 1962804617
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Entity Type | Individual
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Provider Name | NIKOLAS SHAUGHNESSY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 705 ELM ST W
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City | HAMPTON
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State | SC
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Zip | 29924-3105
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Country | US
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Telephone | 803-943-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 BENTON BLVD APT 3307
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City | POOLER
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State | GA
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Zip | 31322-5146
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Country | US
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Telephone | 217-691-0512
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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 | 35745
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 028080
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License Number State | GA
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