Provider Demographics
NPI:1477183093
Name:CRICHLOW, SHANNAN
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:
Last Name:CRICHLOW
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 1:11003 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7401
Mailing Address - Country:US
Mailing Address - Phone:281-669-1250
Mailing Address - Fax:281-669-1252
Practice Address - Street 1:11003 SHADOW CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7401
Practice Address - Country:US
Practice Address - Phone:281-669-1250
Practice Address - Fax:281-669-1252
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX396881835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist