MEDICARE: DR. KRISTI G. SHOCKLEY 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	008658	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	008658	OTHER	SC	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1912296104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTI G. SHOCKLEY PHARMD

Provider Business Mailing Address
First Line	:	5 RUSTCRAFT DR
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29651-5397
Country	:	US
Telephone Number	:	864-979-4121
Fax Number	:	864-895-3105

Provider Business Practice Location Address
First Line	:	2410 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:	864-587-9486
Fax Number	:	864-587-9504

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

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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