| NPI | 1154667079 |
|---|---|
| Former Name | SHANNON DIANNE PUCKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MT 11921) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60292584) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: MT 11921) | |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2020-05-13 |