Shane Mouser, PHARM.D.
Individual provider Active NPI Pharmacist · Portland, TN
NPI 1881076321 · NPPES record last updated Feb 9, 2023
Key facts
- NPI
- 1881076321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 39160 (TN)
- Practice address
- 705 S Broadway St
Portland, TN 37148-1628 - Phone
- (615) 323-5050
- Fax
- (615) 323-5052
- NPI assigned
- Jun 22, 2015
- 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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39160 | TN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 39160 | TN | Yes |
Addresses
Primary practice location
705 S Broadway St
Portland, TN 37148-1628
Mailing address
503 Calista Rd
White House, TN 37188-9158
Phone (615) 681-1060
Other providers in Portland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.