MEDICARE: SHANA LEE STROOP

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	25110	NC

General Provider Information

NPI Number	:	1528430105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA LEE STROOP

Provider Business Mailing Address
First Line	:	207 BLYTHE MILL RD
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-7080
Country	:	US
Telephone Number	:	231-343-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	5040 BEATTIES FORD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2835
Country	:	US
Telephone Number	:	704-394-1714
Fax Number	:

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

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	10/22/2015

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Directions to “ SHANA LEE STROOP ” Practice Location

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