Provider Demographics
NPI:1285255687
Name:SLATE, SHANNON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:SLATE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:DANIELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:137 DEVONSHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5810
Mailing Address - Country:US
Mailing Address - Phone:615-822-1123
Mailing Address - Fax:615-367-1808
Practice Address - Street 1:217 W MAPLEWOOD LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2981
Practice Address - Country:US
Practice Address - Phone:615-277-5900
Practice Address - Fax:615-367-1808
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0216821835N1003X
TN132121835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support