Shawn Evan Andrus

Individual provider Active NPI Pharmacist · Oklahoma City, OK

NPI 1134423528 · NPPES record last updated Dec 29, 2010

Key facts

NPI
1134423528
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
10547 (OK)
Practice address
3500 Chesterfield PL
Oklahoma City, OK 73179-6019
Phone
(405) 745-5004
Fax
(405) 745-5004
NPI assigned
Dec 29, 2010
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1-14985KSMDPharmacist
2010038516MOMDPharmacist
17848NVMDPharmacist
10547OKMDPharmacist
27756TXMDPharmacist
0202210139VAMDPharmacist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 10547 OK Yes
Pharmacist 183500000X 27756 TX
Pharmacist 183500000X 2010038516 MO
Pharmacist 183500000X 17848 NV
Pharmacist 183500000X 1-14985 KS
Pharmacist 183500000X 0202210139 VA

Addresses

Primary practice location

3500 Chesterfield PL
Oklahoma City, OK 73179-6019

Mailing address

3500 Chesterfield PL
Oklahoma City, OK 73179-6019
Phone (405) 745-5004

Other providers in Oklahoma City, OK

All providers in Oklahoma City, OK · Pharmacist in Oklahoma

Sources for this page

Verify at the official NPI Registry.