Provider Demographics
NPI:1740892231
Name:WEST, SHAQUANA BREQUESHA (PHARMD)
Entity type:Individual
Prefix:
First Name:SHAQUANA
Middle Name:BREQUESHA
Last Name:WEST
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 1:987 MOUNT SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:ENOREE
Mailing Address - State:SC
Mailing Address - Zip Code:29335-2130
Mailing Address - Country:US
Mailing Address - Phone:864-237-5393
Mailing Address - Fax:
Practice Address - Street 1:1905 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2308
Practice Address - Country:US
Practice Address - Phone:864-253-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist