Provider Demographics
NPI:1063064624
Name:FAULKENBERRY, SHANNON BARNES (PHARMD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BARNES
Last Name:FAULKENBERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 RIDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7063
Mailing Address - Country:US
Mailing Address - Phone:803-223-4025
Mailing Address - Fax:
Practice Address - Street 1:9712 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4379
Practice Address - Country:US
Practice Address - Phone:803-788-8582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist