Provider Demographics
NPI:1760098289
Name:EMMERT, SHANNON RENEE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:EMMERT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 ROBERT C BYRD DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5239
Mailing Address - Country:US
Mailing Address - Phone:304-253-2738
Mailing Address - Fax:304-253-9087
Practice Address - Street 1:2811 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5239
Practice Address - Country:US
Practice Address - Phone:304-253-2738
Practice Address - Fax:304-253-9087
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist