Provider Demographics
NPI:1295033413
Name:NEAVINS, SHAUNA NICOLE (PHARM)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:NICOLE
Last Name:NEAVINS
Suffix:
Gender:F
Credentials:PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16310 RAPTOR CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8772
Mailing Address - Country:US
Mailing Address - Phone:704-906-1290
Mailing Address - Fax:
Practice Address - Street 1:16310 RAPTOR COURT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-8772
Practice Address - Country:US
Practice Address - Phone:704-906-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist