Provider Demographics
NPI:1053747436
Name:THAXTER, SHUNDRANEKA L (PHARM D)
Entity type:Individual
Prefix:
First Name:SHUNDRANEKA
Middle Name:L
Last Name:THAXTER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6841 MEADOWS END LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-1301
Mailing Address - Country:US
Mailing Address - Phone:731-217-9746
Mailing Address - Fax:
Practice Address - Street 1:2471 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38108-3318
Practice Address - Country:US
Practice Address - Phone:901-454-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist