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NPI Code Detail

MEDICARE: DANA SHOOK ELAM BS PHARMACY

MEDICARE: DANA SHOOK ELAM BS PHARMACY
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
1183500000XPharmacist0202012106VA

General Provider Information

NPI Number : 1356610463
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANA SHOOK ELAM BS PHARMACY
Provider Business Mailing Address
First Line : 112 BROWNS WAY RD
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-9507
Country : US
Telephone Number : 804-897-0977
Fax Number : 804-897-1198
Provider Business Practice Location Address
First Line : 112 BROWNS WAY RD
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-9507
Country : US
Telephone Number : 804-897-0977
Fax Number : 804-897-1198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2011
Last Update Date : 12/19/2011

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