MEDICARE: SHANNON C NELSON PHARMD

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	10288	NE

General Provider Information

NPI Number	:	1487636023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON C NELSON PHARMD

Provider Business Mailing Address
First Line	:	6904 BETH AVE
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68133-2119
Country	:	US
Telephone Number	:	402-658-4556
Fax Number	:

Provider Business Practice Location Address
First Line	:	6904 BETH AVE
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68133-2119
Country	:	US
Telephone Number	:	402-658-4556
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	05/29/2013

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Directions to “ SHANNON C NELSON PHARMD” Practice Location

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