Provider Demographics
NPI:1932415163
Name:SHANNON, MEGAN ROSE (RPH)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 N MAYO TRL
Mailing Address - Street 2:KMART PHARMACY #4827
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1804
Mailing Address - Country:US
Mailing Address - Phone:606-789-3738
Mailing Address - Fax:606-788-1407
Practice Address - Street 1:334 N MAYO TRL
Practice Address - Street 2:KMART PHARMACY #4827
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1804
Practice Address - Country:US
Practice Address - Phone:606-789-3738
Practice Address - Fax:606-788-1407
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY011390OtherLICENSE NUMBER