Provider Demographics
NPI:1982692885
Name:GOBLIRSCH, SHANNON MARIE (PHARMD,RPH)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:GOBLIRSCH
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:39648 RESERVATION HIGHWAY 3
Mailing Address - City:MORTON
Mailing Address - State:MN
Mailing Address - Zip Code:56270-0299
Mailing Address - Country:US
Mailing Address - Phone:507-697-8950
Mailing Address - Fax:507-697-8954
Practice Address - Street 1:39648 RESERVATION HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MN
Practice Address - Zip Code:56270-0299
Practice Address - Country:US
Practice Address - Phone:507-697-8950
Practice Address - Fax:507-697-8954
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117045-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist