Healthcare Provider Details

I. General information

NPI: 1154667079
Provider Name (Legal Business Name): SHANNON DIANNE PUCKETT MAY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON DIANNE PUCKETT PHARM.D.

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 27TH ST
BILLINGS MT
59101-4227
US

IV. Provider business mailing address

2713 STINSON PL
BILLINGS MT
59102-1344
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3350
  • Fax: 406-247-3389
Mailing address:
  • Phone: 406-459-6559
  • Fax: 406-238-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60292584
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number11921
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11921
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: