Healthcare Provider Details

I. General information

NPI: 1447165543
Provider Name (Legal Business Name): SHANE WAITE MCCONNELL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 N MASSEY BLVD
NIXA MO
65714-7607
US

IV. Provider business mailing address

1105 N 20TH AVE
OZARK MO
65721-6736
US

V. Phone/Fax

Practice location:
  • Phone: 417-724-0798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026036395
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: