Provider Demographics
NPI:1932579083
Name:SHOCKLEY, DAKOTA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:SHOCKLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LIBERTY LN
Mailing Address - Street 2:APARTMENT 602
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3648
Mailing Address - Country:US
Mailing Address - Phone:931-993-1869
Mailing Address - Fax:
Practice Address - Street 1:12290 HIGHWAY 231 431 N
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-1200
Practice Address - Country:US
Practice Address - Phone:256-828-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18958183500000X
TN39574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist