Provider Demographics
NPI:1376927681
Name:EASTON, SHANTORIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANTORIA
Middle Name:
Last Name:EASTON
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 1:5244 EDGEWOOD CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-3601
Mailing Address - Country:US
Mailing Address - Phone:904-487-4578
Mailing Address - Fax:
Practice Address - Street 1:5244 EDGEWOOD CT
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3601
Practice Address - Country:US
Practice Address - Phone:904-487-4578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist