Provider Demographics
NPI:1427356369
Name:GARY, SHAVONDA GRIFFIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHAVONDA
Middle Name:GRIFFIN
Last Name:GARY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 GREENVILLE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DONALDS
Mailing Address - State:SC
Mailing Address - Zip Code:29638-9310
Mailing Address - Country:US
Mailing Address - Phone:864-456-2480
Mailing Address - Fax:
Practice Address - Street 1:1014 MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1450
Practice Address - Country:US
Practice Address - Phone:864-223-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist