Healthcare Provider Details

I. General information

NPI: 1689725673
Provider Name (Legal Business Name): M SHAWN ANDERSON RPH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5366 NW CACHE RD SUITE 1
LAWTON OK
73505-3335
US

IV. Provider business mailing address

5366 NW CACHE RD SUITE 1
LAWTON OK
73505-3335
US

V. Phone/Fax

Practice location:
  • Phone: 580-595-9500
  • Fax: 580-585-6524
Mailing address:
  • Phone: 580-595-9500
  • Fax: 580-585-6524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number35177
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHAWN ANDERSON
Title or Position: PIC, PRESIDENT
Credential: RPH
Phone: 580-595-9500