Provider Demographics
NPI:1700141025
Name:BOSTIC, SHAUNELL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SHAUNELL
Middle Name:
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9739 KINGS PARADE BLVD
Mailing Address - Street 2:UNIT 208
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5686
Mailing Address - Country:US
Mailing Address - Phone:704-737-3201
Mailing Address - Fax:
Practice Address - Street 1:9870 REA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6655
Practice Address - Country:US
Practice Address - Phone:704-264-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist