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NPI Code Detail

MEDICARE: SHANNON HAYNES

MEDICARE: SHANNON HAYNES
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
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1225639529
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON HAYNES
Provider Business Mailing Address
First Line : 2245 JACKSBORO HWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76114-2319
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2245 JACKSBORO HWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76114-2319
Country : US
Telephone Number : 817-569-6241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2020
Last Update Date : 11/03/2020

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Directions to “ SHANNON HAYNES ” Practice Location

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