Healthcare Provider Details

I. General information

NPI: 1538260872
Provider Name (Legal Business Name): SHAUN E SWARTZ II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 WEST 14TH
SULPHUR OK
73086
US

IV. Provider business mailing address

815 WEST BROADWAY
SULPHUR OK
73086
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-2208
  • Fax: 580-622-2200
Mailing address:
  • Phone: 580-622-2208
  • Fax: 580-622-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT-133
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: