Provider Demographics
NPI:1154688307
Name:SHANNON, JENNIFER ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 OLD PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2937
Mailing Address - Country:US
Mailing Address - Phone:678-407-7369
Mailing Address - Fax:678-407-7347
Practice Address - Street 1:625 OLD PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2937
Practice Address - Country:US
Practice Address - Phone:678-407-7369
Practice Address - Fax:678-407-7347
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0248051835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist