Provider Demographics
NPI:1174640601
Name:CLINTON, SHAMIKA LATASHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:LATASHA
Last Name:CLINTON
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 1:2929 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8535
Mailing Address - Country:US
Mailing Address - Phone:478-971-2557
Mailing Address - Fax:478-971-2557
Practice Address - Street 1:2929 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8535
Practice Address - Country:US
Practice Address - Phone:478-971-2557
Practice Address - Fax:478-971-2557
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023264183500000X
SC11422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist