Provider Demographics
NPI:1336552975
Name:OVERTON, SHANNON (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:
Last Name:OVERTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3101
Mailing Address - Country:US
Mailing Address - Phone:215-681-7286
Mailing Address - Fax:610-586-1240
Practice Address - Street 1:1838 DELMAR DR
Practice Address - Street 2:
Practice Address - City:FOLCROFT
Practice Address - State:PA
Practice Address - Zip Code:19032-1414
Practice Address - Country:US
Practice Address - Phone:610-586-0169
Practice Address - Fax:610-586-1240
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044960L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist