MEDICARE: SHAN JOSHUA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20895	OK

General Provider Information

NPI Number	:	1447049317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAN JOSHUA

Provider Business Mailing Address
First Line	:	6437 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-6503
Country	:	US
Telephone Number	:	405-495-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	6437 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-6503
Country	:	US
Telephone Number	:	405-495-1040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/06/2025

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Directions to “ SHAN JOSHUA ” Practice Location

Language	Start Address	Practice Location

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