Provider Demographics
NPI:1144544768
Name:MOHR, SHANNON (RPH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MOHR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 CALICO RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5974
Mailing Address - Country:US
Mailing Address - Phone:618-969-0918
Mailing Address - Fax:
Practice Address - Street 1:1909 CALICO RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5974
Practice Address - Country:US
Practice Address - Phone:618-969-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293167183500000X
MO2001030600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist