Individual
MR. CHARLES A. SHANNON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
711 N UNION AVE, ROSWELL, NM 88201-3955
(505) 622-6571
(505) 623-3801
Mailing address
711 N UNION AVE, ROSWELL, NM 88201-3955
(505) 622-6571
(505) 623-3801
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3851
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3851
NM PHARACIST ID NUMBER
NM
Enumeration date
09/21/2005
Last updated
07/08/2007
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