Provider Demographics
NPI:1982331344
Name:DALY, SHANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:DALY
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 1:4206 HIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3106
Mailing Address - Country:US
Mailing Address - Phone:304-206-7994
Mailing Address - Fax:
Practice Address - Street 1:4712 MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3630
Practice Address - Country:US
Practice Address - Phone:423-942-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist