Individual
SHANNON G WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4031 POPPS FERRY RD, #A, DIBERVILLE, MS 39540-2367
(228) 392-7310
Mailing address
6721 WASHINGTON AVE, APT 7B, OCEAN SPRINGS, MS 39564-2144
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8370
MS
Other
Enumeration date
06/24/2011
Last updated
06/24/2011
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