Provider Demographics
NPI:1801650544
Name:DIGUILIO, SHIANN CAROL
Entity type:Individual
Prefix:
First Name:SHIANN
Middle Name:CAROL
Last Name:DIGUILIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MASSACHUSETTS AVE LOT 97
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-3839
Mailing Address - Country:US
Mailing Address - Phone:850-287-9722
Mailing Address - Fax:
Practice Address - Street 1:5149 N 9TH AVE STE 1137
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8734
Practice Address - Country:US
Practice Address - Phone:850-477-7568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT93904183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician