Provider Demographics
NPI:1285845214
Name:SHANNON MEDICAL CENTER
Entity Type:Organization
Organization Name:SHANNON MEDICAL CENTER
Other - Org Name:SHANNON MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR-OUTPATIENT PHARMACY SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:325-374-4446
Mailing Address - Street 1:2030 PULLIAM ST STE 16
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76905-5170
Mailing Address - Country:US
Mailing Address - Phone:325-481-6403
Mailing Address - Fax:325-481-8708
Practice Address - Street 1:120 E HARRIS AVE STE 410
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5904
Practice Address - Country:US
Practice Address - Phone:325-747-5389
Practice Address - Fax:325-481-8708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHANNON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy