Provider Demographics
NPI:1649578493
Name:SHIPE-CANNON, DANA LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:LYNN
Last Name:SHIPE-CANNON
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 1:8153 TIMBERLAKE LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3997
Mailing Address - Country:US
Mailing Address - Phone:804-559-9645
Mailing Address - Fax:804-559-9645
Practice Address - Street 1:8153 TIMBERLAKE LN
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3997
Practice Address - Country:US
Practice Address - Phone:804-559-9645
Practice Address - Fax:804-559-9645
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist