Provider Demographics
NPI:1417559709
Name:SHIRLEY, BARBARA ANN
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:SHIRLEY
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 1:4196 BEMISS RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7830
Mailing Address - Country:US
Mailing Address - Phone:229-588-7577
Mailing Address - Fax:229-588-7576
Practice Address - Street 1:4196 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7830
Practice Address - Country:US
Practice Address - Phone:229-588-7577
Practice Address - Fax:229-588-7576
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist