Provider Demographics
NPI:1982954319
Name:SHAUGHNESSY, JOHN C (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:SHAUGHNESSY
Suffix:
Gender:M
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 1:1141 STATE PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609
Mailing Address - Country:US
Mailing Address - Phone:864-240-7421
Mailing Address - Fax:864-250-1642
Practice Address - Street 1:1141 STATE PARK ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609
Practice Address - Country:US
Practice Address - Phone:864-240-7421
Practice Address - Fax:864-250-1642
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist