Provider Demographics
NPI:1689277444
Name:SPEYER, SHANNON LEE (RPH)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:SPEYER
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 1:1470 N QUINN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2958
Mailing Address - Country:US
Mailing Address - Phone:716-704-2349
Mailing Address - Fax:
Practice Address - Street 1:1100 NEW JERSEY AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3302
Practice Address - Country:US
Practice Address - Phone:202-488-2364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100003436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist