Laura Bradley Shack | Johns Creek, GA • PECOS Search

Laura Bradley Shack

Pharmacist

Pharmacy Service Providers

535 Brightmore Downs, Johns Creek, GA 30005-6705

PECOS Enrollment

Based on the most recent information from CMS, provider Laura Bradley Shack does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1437562303
Provider Type
Individual
Full Name
Shack, Laura Bradley
Title
Mrs.
Credential
RPH

Gender
Female
Sole Proprietor
No
Enumeration Date
6/8/2014
Last Updated
6/8/2014

Contact Information

Practice Location

535 Brightmore Downs, Johns Creek, GA 30005-6705

Unlisted Fax

Mailing Location

535 Brightmore Downs, Johns Creek, GA 30005-6705

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 183500000X Primary	Description Pharmacist Pharmacy Service Providers	License 025529 Georgia