Provider Demographics
NPI:1922603851
Name:HORTON, SHAWN CARROLL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:CARROLL
Last Name:HORTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ABE LINCOLN CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-7112
Mailing Address - Country:US
Mailing Address - Phone:423-895-1197
Mailing Address - Fax:
Practice Address - Street 1:2111 N ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2516
Practice Address - Country:US
Practice Address - Phone:423-282-6631
Practice Address - Fax:423-610-0603
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist