Provider Demographics
NPI:1700160694
Name:SHANNON, KIMBERLY EVETTE (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EVETTE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4712
Mailing Address - Country:US
Mailing Address - Phone:941-729-5250
Mailing Address - Fax:941-729-7899
Practice Address - Street 1:930 8TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4712
Practice Address - Country:US
Practice Address - Phone:941-729-5250
Practice Address - Fax:941-729-7899
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist