Provider Demographics
NPI:1255626008
Name:PHILLIPS, SHANNON CARNATHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CARNATHAN
Last Name:PHILLIPS
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 1:401 S MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6359
Mailing Address - Country:US
Mailing Address - Phone:615-758-3322
Mailing Address - Fax:615-758-3499
Practice Address - Street 1:401 S MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6359
Practice Address - Country:US
Practice Address - Phone:615-758-3322
Practice Address - Fax:615-758-3499
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist