Provider Demographics
NPI:1285227710
Name:SPELLS, SHAMOON
Entity Type:Individual
Prefix:
First Name:SHAMOON
Middle Name:
Last Name:SPELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ANCESTRY LN
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-6723
Mailing Address - Country:US
Mailing Address - Phone:843-532-7156
Mailing Address - Fax:
Practice Address - Street 1:135 ANCESTRY LN
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-6723
Practice Address - Country:US
Practice Address - Phone:843-532-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist