Provider Demographics
NPI:1669568234
Name:FREDERICK, SHANNON CARRELL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:CARRELL
Last Name:FREDERICK
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 1:6320 PATRIOTS PASS
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-3721
Mailing Address - Country:US
Mailing Address - Phone:205-661-0180
Mailing Address - Fax:205-655-0129
Practice Address - Street 1:465 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1418
Practice Address - Country:US
Practice Address - Phone:205-661-1110
Practice Address - Fax:205-655-0129
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist