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General NPI Number Information
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NPI Number | 1811580764
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Entity Type | Individual
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Provider Name | TYLER SHANNON
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Gender | Male
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 15951 LITTLE AXE DR
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City | NORMAN
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State | OK
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Zip | 73026-9088
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Country | US
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Telephone | 405-292-9530
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Fax | 405-701-7930
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Provider Business Mailing Address
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Address Line | 3917 CARMONA LAKES DR
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City | MOORE
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State | OK
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Zip | 73160-0012
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Country | US
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Telephone | 918-721-1482
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 19177
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | I-9469
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License Number State | OK
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