Active NPI
Samuel Kenneth Shaner
- Student in an Organized Health Care Education/Training Program
- Tucson, AZ
National Provider Identifier
1366192882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- I026653
- Practice address
- 825 E University Blvd Ste 101
Tucson, AZ 85719-5046 - Phone
- (520) 624-4519
- NPI assigned
- Mar 27, 2022
- Last updated
- Aug 4, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | I026653 | AZ | Primary |
| Pharmacy Technician | 183700000X | T073006 | AZ |
Addresses
Primary practice location
825 E University Blvd Ste 101
Tucson, AZ 85719-5046
Mailing address
825 E University Blvd Ste 101
Tucson, AZ 85719-5046
Phone (520) 624-4519
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 |
|---|---|---|---|
| T073006 | AZ | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| German Dobson CVS LLC | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| German Dobson CVS LLC | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 4
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": "1648339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785801600000",
"number": "1366192882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 E UNIVERSITY BLVD STE 101",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857195046",
"telephone_number": "520-624-4519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 E UNIVERSITY BLVD STE 101",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857195046",
"telephone_number": "520-624-4519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANER",
"first_name": "SAMUEL",
"middle_name": "KENNETH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-27",
"last_updated": "2026-08-04",
"certification_date": "2026-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "AZ",
"license": "I026653",
"primary": true
},
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "AZ",
"license": "T073006",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.