Healthcare Provider Details

I. General information

NPI: 1124574496
Provider Name (Legal Business Name): KRISTIN SHENEMAN PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W. 9TH STREET
WELEETKA OK
74880
US

IV. Provider business mailing address

PO BOX 727
WELEETKA OK
74880
US

V. Phone/Fax

Practice location:
  • Phone: 405-786-2247
  • Fax: 405-786-2409
Mailing address:
  • Phone: 405-786-2247
  • Fax: 405-786-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16009
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: