Basic Information
| Provider Information | |||||||||
| NPI: | 1417610445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRICKLAND | ||||||||
| FirstName: | SHAWANDA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N GRACE ST | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278045345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523168220 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 N GRACE ST | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278045345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523168220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2021 | ||||||||
| LastUpdateDate: | 10/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | 18138 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.