Provider Demographics
NPI:1750097929
Name:WHEELOCK, SHANNON ROSEMARY (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ROSEMARY
Last Name:WHEELOCK
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:ROSEMARY
Other - Last Name:MCELWAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:192 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:CLAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13322-2560
Mailing Address - Country:US
Mailing Address - Phone:315-507-7749
Mailing Address - Fax:
Practice Address - Street 1:1750 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5418
Practice Address - Country:US
Practice Address - Phone:315-266-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist