Healthcare Provider Details

I. General information

NPI: 1194612093
Provider Name (Legal Business Name): ALLYSON SHORES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MOORE AVE
CLAREMORE OK
74017-5047
US

IV. Provider business mailing address

1930 S 74TH EAST AVE
TULSA OK
74112-7716
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-6489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20594
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: