Provider Demographics
NPI:1922268036
Name:STEWART, SHANNON LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEIGH
Last Name:STEWART
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 1:1410 CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3278
Mailing Address - Country:US
Mailing Address - Phone:901-466-7760
Mailing Address - Fax:
Practice Address - Street 1:1410 CHERRY RD
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3278
Practice Address - Country:US
Practice Address - Phone:901-466-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN105191835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric