Organization
SHANNON MEDICAL CENTER
Active
Other names
Shannon Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH WOOLDRIDGE (CFO)
(325) 747-5303
Entity
Organization
Contact information
Practice address
2030 PULLIAM ST STE 16, SAN ANGELO, TX 76905-5170
(325) 747-4246
(325) 285-1383
Mailing address
1620 W NORTHWEST HWY STE 100, GRAPEVINE, TX 76051-3219
(817) 572-0009
(817) 572-0221
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35645
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
05/09/2023
Last updated
03/14/2025
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