1902303712 NPI number — SHANETTE WILKERSON NORTON PHARM.D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902303712 NPI number — SHANETTE WILKERSON NORTON PHARM.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORTON
Provider First Name:
SHANETTE
Provider Middle Name:
WILKERSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILKERSON
Provider Other First Name:
SHANETTE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902303712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7386 HARBOUR TOWNE PKWY STE 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23435-3464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-483-4129
Provider Business Mailing Address Fax Number:
757-483-4240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7386 HARBOUR TOWNE PKWY
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-483-4129
Provider Business Practice Location Address Fax Number:
757-483-4240
Provider Enumeration Date:
04/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0202210887 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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