Provider Demographics
NPI:1235688961
Name:SHANKS, FELECIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FELECIA
Middle Name:
Last Name:SHANKS
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 1:701B HOGUE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-1923
Mailing Address - Country:US
Mailing Address - Phone:770-684-7889
Mailing Address - Fax:770-684-1550
Practice Address - Street 1:701B HOGUE AVE
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-1923
Practice Address - Country:US
Practice Address - Phone:770-684-7889
Practice Address - Fax:770-684-1550
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist