Provider Demographics
NPI:1669119814
Name:GRADERT, SHANNON KATHLEEN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:GRADERT
Suffix:
Gender:
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:KATHLEEN
Other - Last Name:HALLORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:3935 CARRIAGE GATE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 PLEASANT HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5863
Practice Address - Country:US
Practice Address - Phone:770-806-2787
Practice Address - Fax:770-638-7642
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist