Active NPI
Shannon Jewelanna Pruett, D.PH.
- Pharmacist
- Broken Bow, OK
National Provider Identifier
1033118286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12491
- Practice address
- 201 S Park Dr
Broken Bow, OK 74728-4737 - Phone
- (580) 584-6085
- Fax
- (580) 584-6088
- NPI assigned
- Jul 19, 2005
- Last updated
- Jan 31, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12491 | OK | Primary |
Addresses
Primary practice location
201 S Park Dr
Broken Bow, OK 74728-4737
Mailing address
692 Old Military Road
Broken Bow, OK 74728-9659
Phone (580) 584-6089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12491 | OK | MD | Pharmacist |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612051200000",
"number": "1033118286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "692 OLD MILITARY ROAD",
"city": "BROKEN BOW",
"state": "OK",
"postal_code": "747289659",
"telephone_number": "580-584-6089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 S PARK DR",
"city": "BROKEN BOW",
"state": "OK",
"postal_code": "747284737",
"telephone_number": "580-584-6085",
"fax_number": "580-584-6088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUETT",
"first_name": "SHANNON",
"middle_name": "JEWELANNA",
"name_prefix": "Ms.",
"credential": "D.PH.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-07-19",
"last_updated": "2021-01-31",
"certification_date": "2021-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "12491",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Bow, OK
- Anne Mary Orr, DDS
- Chad Erick Orr, DDS
- Heather Renee Payne
- Faith Lucille Phillips, PH.D.
- Professional Counseling Associates of McCurtain County, Inc. (Full Life Family Resource Center)
- Pruetts Food Inc (Pruett Foods Pharmacy)
- Jessica Pruitt
- Kimberly Reece, NP-C
- Chelsea Richardson, MA, LPC
- Jacqueline Sue Rollins, CP-N
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.