Provider Demographics
NPI:1104110139
Name:PEPPER, SHANNON W (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:W
Last Name:PEPPER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINDCHIME CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7101
Mailing Address - Country:US
Mailing Address - Phone:803-641-4276
Mailing Address - Fax:
Practice Address - Street 1:2545 WHISKEY RD
Practice Address - Street 2:TARGET PHARMACY 1310
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8521
Practice Address - Country:US
Practice Address - Phone:803-644-2711
Practice Address - Fax:803-644-2711
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist