Shannon Berry
Individual provider Active NPI Pharmacist · Belton, MO
NPI 1679174643 · NPPES record last updated Apr 1, 2022
Key facts
- NPI
- 1679174643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2015025621 (MO)
- Practice address
- 1307 E North Ave
Belton, MO 64012-5109 - Phone
- (816) 318-0404
- Fax
- (816) 318-0446
- NPI assigned
- Nov 5, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015025621 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2015025621 | MO | Yes |
Addresses
Primary practice location
1307 E North Ave
Belton, MO 64012-5109
Mailing address
104 Frederick LN
Raymore, MO 64083-9738
Phone (816) 914-7533
Other practice location 1
1712 E Ohio St
Clinton, MO 64735-2402
Phone (660) 890-2587
Other providers in Belton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2022. 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.