Provider Demographics
NPI:1740302777
Name:CROSBY, SHANNON ROBERTS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ROBERTS
Last Name:CROSBY
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 1:129 MYRICK DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-6761
Mailing Address - Country:US
Mailing Address - Phone:478-935-2318
Mailing Address - Fax:478-633-8825
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-8128
Practice Address - Fax:478-633-8825
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist