NPIMap

Individual provider Active NPI

Shawn David Tankersley, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • London, KY
National Provider Identifier
1669628863
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X
License
013381 Issued in KY
Practice address
1732 Highway 192 W
London, KY 40741-1675
Phone
(606) 878-1568
Fax
(606) 878-1851
NPI assigned
Aug 7, 2008
Last updated
Feb 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 013381 KY
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 013381 KY Primary

Addresses

Primary practice location

1732 Highway 192 W
London, KY 40741-1675

Mailing address

1732 Highway 192 W
London, KY 40741-1675
Phone (606) 878-1568

Other practice location 1

181 S Highway 27
Somerset, KY 42501-1779
Phone (606) 451-4341

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
013381KYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Kroger Limited Partnership I Past Accepting new patients
Kroger Limited Partnership I Past Accepting new patients
Kroger Limited Partnership I PastSince Feb 9, 2020 Accepting new patients

Organizations & group practices 3

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": "1218067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1669628863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1732 HIGHWAY 192 W",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407411675",
            "telephone_number": "606-878-1568",
            "fax_number": "606-878-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1732 HIGHWAY 192 W",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407411675",
            "telephone_number": "606-878-1568",
            "fax_number": "606-878-1851"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "181 S Highway 27",
            "address_purpose": "LOCATION",
            "city": "Somerset",
            "state": "KY",
            "postal_code": "425011779",
            "country_code": "US",
            "telephone_number": "606-451-4341",
            "fax_number": "606-451-4343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANKERSLEY",
        "first_name": "SHAWN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-07",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "013381",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "KY",
            "license": "013381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.