Active NPI
Shannon Bonnarens
- Pharmacist
- Lawton, OK
National Provider Identifier
1104405257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12893
- Practice address
- 5602 SW Lee Blvd
Lawton, OK 73505-9635 - Phone
- (580) 531-4712
- NPI assigned
- Apr 6, 2021
- Sex
- Female
- Sole proprietor
- No
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 | 12893 | OK | Primary |
Addresses
Primary practice location
5602 SW Lee Blvd
Lawton, OK 73505-9635
Mailing address
PO Box 693
Cache, OK 73527-0693
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 |
|---|---|---|---|
| 12893 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617667200000",
"number": "1104405257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 693",
"city": "CACHE",
"state": "OK",
"postal_code": "735270693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5602 SW LEE BLVD",
"city": "LAWTON",
"state": "OK",
"postal_code": "735059635",
"telephone_number": "580-531-4712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONNARENS",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-06",
"last_updated": "2021-04-06",
"certification_date": "2021-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "12893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.