Individual ProviderShanceline Esom TeboPharmacistPharmacy Service ProvidersPractice Address60 Mdg/Mdts, 101 Bodin Circle, Travis Afb, CA 94535-1809(707) 423-7657PECOS EnrollmentBased on the most recent information from CMS, provider Shanceline Esom Tebo does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:10 AM.Profile DetailsProvider ID1962259218Provider TypeIndividualFull NameTebo, Shanceline EsomGenderFemaleSole ProprietorNoEnumeration Date5/3/2024Last Updated7/16/2024Contact InformationPractice LocationPractice Address60 Mdg/Mdts, 101 Bodin Circle, Travis Afb, CA 94535-1809Phone(707) 423-7657FaxUnlisted FaxMailing LocationMailing Address60 Mdg/Mdts, 101 Bodin Circle, Travis Afb, CA 94535-1809PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense10860415-1701Utah