| NPI | 1295304335 |
|---|---|
| Former Name | SHANNAN STREET |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: DE A1-0015520) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0015520) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2022-01-18 |