Provider Demographics
NPI:1124785803
Name:SHANNON-ECKHARDT, ALEXANDER JOSEPH (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOSEPH
Last Name:SHANNON-ECKHARDT
Suffix:
Gender:M
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:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:DENNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02639-0969
Mailing Address - Country:US
Mailing Address - Phone:585-490-4364
Mailing Address - Fax:
Practice Address - Street 1:9 WEST RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3200
Practice Address - Country:US
Practice Address - Phone:508-225-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist