Provider Demographics
NPI:1154442523
Name:IVEY, SHANNON W (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:W
Last Name:IVEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 COUNTY ROAD 12
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-3539
Mailing Address - Country:US
Mailing Address - Phone:256-447-0155
Mailing Address - Fax:256-447-6054
Practice Address - Street 1:702 HIGHWAY 278 EAST BYPASS
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272
Practice Address - Country:US
Practice Address - Phone:256-447-7779
Practice Address - Fax:256-447-6054
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12399183500000X
GA16588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist