Provider Demographics
NPI:1619578242
Name:STRONG, DENISA SHANTEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DENISA
Middle Name:SHANTEE
Last Name:STRONG
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 1:764 ORLEANS CIR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4722
Mailing Address - Country:US
Mailing Address - Phone:601-529-4090
Mailing Address - Fax:
Practice Address - Street 1:131 HANDLEY BLVD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-8983
Practice Address - Country:US
Practice Address - Phone:769-237-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE09644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist