MEDICARE: SHANNON RAINES THOMPSON RPH

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	RPH018053	GA
2	183500000X	Pharmacist	13515	AL

General Provider Information

NPI Number	:	1497341259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON RAINES THOMPSON RPH

Provider Business Mailing Address
First Line	:	305 FORREST AVE
Second Line	:
City	:	EAST BREWTON
State	:	AL
Zip	:	36426-2620
Country	:	US
Telephone Number	:	251-809-1010
Fax Number	:	251-241-0020

Provider Business Practice Location Address
First Line	:	305 FORREST AVE
Second Line	:
City	:	EAST BREWTON
State	:	AL
Zip	:	36426-2620
Country	:	US
Telephone Number	:	251-809-1010
Fax Number	:	251-241-0020

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

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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