Provider Demographics
NPI:1568009330
Name:WILLIAMSON, SHANNON LAYNE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LAYNE
Last Name:WILLIAMSON
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 1:16532 GAITHER CT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-4438
Mailing Address - Country:US
Mailing Address - Phone:765-993-2939
Mailing Address - Fax:
Practice Address - Street 1:4750 E 450 S
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-8404
Practice Address - Country:US
Practice Address - Phone:877-732-3431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023376A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist