Provider Demographics
NPI:1548024979
Name:KONWICK, SHAWN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:KONWICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 JAYS WAY
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-8981
Mailing Address - Country:US
Mailing Address - Phone:678-634-6495
Mailing Address - Fax:
Practice Address - Street 1:150 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-8525
Practice Address - Country:US
Practice Address - Phone:706-891-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist