Provider Demographics
NPI:1174297352
Name:SHAHAN, MARJORIE JADE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:JADE
Last Name:SHAHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 BRICK DR
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-8810
Mailing Address - Country:US
Mailing Address - Phone:843-457-2828
Mailing Address - Fax:
Practice Address - Street 1:1201 SEA MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2216
Practice Address - Country:US
Practice Address - Phone:843-361-3784
Practice Address - Fax:843-361-3785
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist