Individual provider Active NPI

Shane Caslavka, PHARMD

  • Pharmacist
  • Summerville, SC
National Provider Identifier
1447114780
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
121907 Issued in MN
Practice address
2015 2ND Ave Ste 204
Summerville, SC 29486-7889
Phone
(843) 793-6980
NPI assigned
Dec 11, 2025
Last updated
Dec 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 121907 MN Primary

Addresses

Primary practice location

2015 2ND Ave Ste 204
Summerville, SC 29486-7889

Mailing address

3125 Noble Ave N
Golden Valley, MN 55422-3014
Phone (763) 234-7155

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
121907MNMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1765411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1447114780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 NOBLE AVE N",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554223014",
            "telephone_number": "763-234-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 2ND AVE STE 204",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294867889",
            "telephone_number": "843-793-6980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASLAVKA",
        "first_name": "SHANE",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-11",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "121907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.