Provider Demographics
NPI:1760932693
Name:LANDRY, SHANNON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:LANDRY
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 1:2601 GENE GEORGE BLVD
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72704
Mailing Address - Country:US
Mailing Address - Phone:479-725-6842
Mailing Address - Fax:
Practice Address - Street 1:2601 GENE GEORGE BLVD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72704
Practice Address - Country:US
Practice Address - Phone:479-725-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55652183500000X
ARPD16031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist