Provider Demographics
NPI:1851760409
Name:DEES, SHALLON
Entity Type:Individual
Prefix:
First Name:SHALLON
Middle Name:
Last Name:DEES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHALLON
Other - Middle Name:MONETTE
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10179 EASTERN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3302
Mailing Address - Country:US
Mailing Address - Phone:251-621-9065
Mailing Address - Fax:
Practice Address - Street 1:10179 EASTERN SHORE DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-3302
Practice Address - Country:US
Practice Address - Phone:251-621-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist