MEDICARE: SHONDRIA ALEXIS LAGUERRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH031457	GA

General Provider Information

NPI Number	:	1053910208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONDRIA ALEXIS LAGUERRE

Provider Business Mailing Address
First Line	:	3959 LAVISTA RD
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-5144
Country	:	US
Telephone Number	:	770-934-6442
Fax Number	:

Provider Business Practice Location Address
First Line	:	3959 LAVISTA RD
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-5144
Country	:	US
Telephone Number	:	770-934-6442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	06/01/2026

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