Provider Demographics
NPI:1902116148
Name:SHANNON, DANIELLE SUE (PHARMD, MSCR)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SUE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PHARMD, MSCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 RYAN DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5157
Mailing Address - Country:US
Mailing Address - Phone:503-587-5103
Mailing Address - Fax:
Practice Address - Street 1:2995 RYAN DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5157
Practice Address - Country:US
Practice Address - Phone:503-587-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445136183500000X
ORRPH0013564183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist