Provider Demographics
NPI:1093345506
Name:BUFORD, SHATORRIE PARRISH
Entity Type:Individual
Prefix:
First Name:SHATORRIE
Middle Name:PARRISH
Last Name:BUFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27955 US HIGHWAY 98 STE 1
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4700
Mailing Address - Country:US
Mailing Address - Phone:251-626-1349
Mailing Address - Fax:
Practice Address - Street 1:461 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8121
Practice Address - Country:US
Practice Address - Phone:251-382-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist