Provider Demographics
NPI:1891279675
Name:SHANNON, STACY PARRISH (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:PARRISH
Last Name:SHANNON
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 1:3281 BRYSON CITY RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-4314
Mailing Address - Country:US
Mailing Address - Phone:828-369-4214
Mailing Address - Fax:
Practice Address - Street 1:120 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-2612
Practice Address - Country:US
Practice Address - Phone:828-369-4214
Practice Address - Fax:828-349-6667
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7001621835P0018X
NC14576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14576OtherNC BOARD OF PHARMACY LICENSE
NC700162OtherCLINICAL PHARMACIST PRACTITIONER