Provider Demographics
NPI:1215431457
Name:RICE, SHANNON DALANIE (PHARMD, BCGP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DALANIE
Last Name:RICE
Suffix:
Gender:F
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WT BROOKSHIRE HALL OFFICE 256 3900 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75799-0001
Mailing Address - Country:US
Mailing Address - Phone:254-724-2524
Mailing Address - Fax:
Practice Address - Street 1:WT BROOKSHIRE HALL OFFICE 256 3900 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75799-0001
Practice Address - Country:US
Practice Address - Phone:903-565-6437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32953390200000X
TX626101835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program