Healthcare Provider Details

I. General information

NPI: 1932018959
Provider Name (Legal Business Name): MICHAEL SHIPMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S SILVER SPRINGS RD
CAPE GIRARDEAU MO
63703-7539
US

IV. Provider business mailing address

208 FRASER RDG
JACKSON MO
63755-4142
US

V. Phone/Fax

Practice location:
  • Phone: 573-708-5093
  • Fax:
Mailing address:
  • Phone: 573-708-5093
  • Fax: 573-708-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2006024049
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: