Healthcare Provider Details

I. General information

NPI: 1235062308
Provider Name (Legal Business Name): SHAWN AIDEN GREGORY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MAINE ST
LAWRENCE KS
66044-1360
US

IV. Provider business mailing address

5401 ROCK CHALK DR APT 6301
LAWRENCE KS
66049-5075
US

V. Phone/Fax

Practice location:
  • Phone: 785-505-6445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3-120562
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: