MEDICARE: DR. SHANNON CARRELL FREDERICK 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	14209	AL

General Provider Information

NPI Number	:	1669568234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON CARRELL FREDERICK PHARMD

Provider Business Mailing Address
First Line	:	6320 PATRIOTS PASS
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-3721
Country	:	US
Telephone Number	:	205-661-0180
Fax Number	:	205-655-0129

Provider Business Practice Location Address
First Line	:	465 MAIN ST
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-1418
Country	:	US
Telephone Number	:	205-661-1110
Fax Number	:	205-655-0129

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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