Provider Demographics
NPI:1114537701
Name:VAN HORN, SHANNON BROOKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:BROOKE
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:BROOKE
Other - Last Name:PROSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:157 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-4001
Mailing Address - Country:US
Mailing Address - Phone:865-360-6915
Mailing Address - Fax:
Practice Address - Street 1:507 FOOTHILLS PLZ
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-2312
Practice Address - Country:US
Practice Address - Phone:865-238-7436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist