Provider Demographics
NPI:1225333750
Name:MOORE, SHANNON N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:N
Last Name:MOORE
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 1:1028 BROOK VALLEY RUN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-6345
Mailing Address - Country:US
Mailing Address - Phone:704-989-3080
Mailing Address - Fax:
Practice Address - Street 1:4300 OLD MONROE RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5305
Practice Address - Country:US
Practice Address - Phone:704-821-6551
Practice Address - Fax:704-821-6583
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist