Provider Demographics
NPI:1740499524
Name:SHOCKLEY, JOEL E III (RPH)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:E
Last Name:SHOCKLEY
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:SC
Mailing Address - Zip Code:29591-5553
Mailing Address - Country:US
Mailing Address - Phone:843-274-4548
Mailing Address - Fax:
Practice Address - Street 1:223 N. JONES RD
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29114
Practice Address - Country:US
Practice Address - Phone:843-396-4431
Practice Address - Fax:843-370-0013
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist