Shane Champ, RPH
Individual provider Active NPI Pharmacist · Nelsonville, OH
NPI 1033645650 · NPPES record last updated May 2, 2017
Key facts
- NPI
- 1033645650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 03321847 (OH)
- Practice address
- 965 Poplar St
Nelsonville, OH 45764-1442 - Phone
- (740) 753-1984
- Fax
- (740) 753-3188
- NPI assigned
- May 2, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03321847 | OH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Co | Past | Accepting new patients | |
| The Kroger Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03321847 | OH | Yes |
Addresses
Primary practice location
965 Poplar St
Nelsonville, OH 45764-1442
Mailing address
965 Poplar St
Nelsonville, OH 45764-1442
Phone (740) 753-1984
Other providers in Nelsonville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.