Provider Demographics
NPI:1124104542
Name:JUSSEL, SHONA (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHONA
Middle Name:
Last Name:JUSSEL
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 1:300 GOLF LN
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-1728
Mailing Address - Country:US
Mailing Address - Phone:605-668-9215
Mailing Address - Fax:
Practice Address - Street 1:2100 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-1705
Practice Address - Country:US
Practice Address - Phone:605-665-8261
Practice Address - Fax:605-665-3371
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist