Provider Demographics
NPI:1578134250
Name:BRABHAM, SHANNON SCARBROUGH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:SCARBROUGH
Last Name:BRABHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2519
Mailing Address - Country:US
Mailing Address - Phone:601-410-5570
Mailing Address - Fax:601-735-5885
Practice Address - Street 1:923 WAYNE ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2571
Practice Address - Country:US
Practice Address - Phone:601-735-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST09088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist