Healthcare Provider Details

I. General information

NPI: 1851308324
Provider Name (Legal Business Name): SHAWNEE REGIONAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S 8TH ST STE B
MCLOUD OK
74851-8633
US

IV. Provider business mailing address

704 S 8TH ST STE B
MCLOUD OK
74851-8633
US

V. Phone/Fax

Practice location:
  • Phone: 405-964-3956
  • Fax: 405-964-3959
Mailing address:
  • Phone: 405-964-3956
  • Fax: 405-964-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10-4899
License Number StateOK

VIII. Authorized Official

Name: LAUREN PALMER
Title or Position: RX MANAGER/CO-OWNER
Credential: PHARM D
Phone: 405-964-3956