Provider Demographics
NPI:1023229168
Name:GILBERT, SHANNON MARY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARY
Last Name:GILBERT
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 1:11166 LYNDALE LN
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9794
Mailing Address - Country:US
Mailing Address - Phone:716-655-6305
Mailing Address - Fax:
Practice Address - Street 1:2887 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-3038
Practice Address - Country:US
Practice Address - Phone:716-854-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051496-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist