Provider Demographics
NPI:1912296104
Name:SHOCKLEY, KRISTI G (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:G
Last Name:SHOCKLEY
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 1:5 RUSTCRAFT DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-5397
Mailing Address - Country:US
Mailing Address - Phone:864-979-4121
Mailing Address - Fax:864-895-3105
Practice Address - Street 1:2410 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3652
Practice Address - Country:US
Practice Address - Phone:864-587-9486
Practice Address - Fax:864-587-9504
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC008658OtherPHARMACIST LICENSE NUMBER