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General NPI Number Information
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NPI Number | 1982140794
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Entity Type | Individual
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Provider Name | SHANNON NICHOLS
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Gender | Female
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 10/27/2024
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Provider Practice Location Address
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Address Line | 7131 HIGHWAY 73
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City | DENVER
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State | NC
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Zip | 28037-9186
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Country | US
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Telephone | 704-827-8228
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Fax |
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Provider Business Mailing Address
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Address Line | 7131 HIGHWAY 73
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City | DENVER
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State | NC
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Zip | 28037-9186
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Country | US
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Telephone | 704-827-8228
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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 | 17810
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License Number State | NC
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