MEDICARE: DR. SHANNON CORNING PHARM.D.

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	183500000X	Pharmacist	PS42413	FL

General Provider Information

NPI Number	:	1184918278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON CORNING PHARM.D.

Provider Business Mailing Address
First Line	:	6331 ROOSEVELT BLVD
Second Line	:	T1853
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-3303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6331 ROOSEVELT BLVD
Second Line	:	T1853
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-3303
Country	:	US
Telephone Number	:	904-596-1066
Fax Number	:	904-596-1066

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

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	06/06/2011

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