Provider Demographics
NPI:1689274730
Name:FOX, SHANNON ASHLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ASHLEY
Last Name:FOX
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 1:2286 HIGHWAY 189 N
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-8728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9424
Practice Address - Country:US
Practice Address - Phone:870-364-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist