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NPI Code Detail

MEDICARE: SHANNON WADSWORTH

MEDICARE: SHANNON WADSWORTH
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
1183500000XPharmacist56613TX

General Provider Information

NPI Number : 1134502503
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON WADSWORTH
Provider Business Mailing Address
First Line : 5225 BUFFALO SPEEDWAY
Second Line :
City : HOUSTON
State : TX
Zip : 77005-4210
Country : US
Telephone Number : 713-664-3426
Fax Number : 713-664-2342
Provider Business Practice Location Address
First Line : 5225 BUFFALO SPEEDWAY
Second Line :
City : HOUSTON
State : TX
Zip : 77005-4210
Country : US
Telephone Number : 713-664-3426
Fax Number : 713-664-2342
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2015
Last Update Date : 07/03/2015

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Directions to “ SHANNON WADSWORTH ” Practice Location

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