Provider Demographics
NPI:1699942508
Name:PITTMAN, SHAUNA SOUTHARD
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:SOUTHARD
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SHAUNA
Other - Middle Name:LYNN
Other - Last Name:SOUTHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8012 FERNCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-3001
Mailing Address - Country:US
Mailing Address - Phone:703-455-4647
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL ROAD
Practice Address - Street 2:DEWITT HEALTHCARE NETWORK
Practice Address - City:FT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-805-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0087211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist