Healthcare Provider Details

I. General information

NPI: 1013549146
Provider Name (Legal Business Name): SHAWNA WALLEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 EUCLID AVE
LEXINGTON KY
40502-1740
US

IV. Provider business mailing address

133 S TAYLOR LN
GEORGETOWN KY
40324-9798
US

V. Phone/Fax

Practice location:
  • Phone: 859-687-3270
  • Fax:
Mailing address:
  • Phone: 859-221-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number010675
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: