Provider Demographics
NPI:1013004647
Name:STINNETT, SHAUNA BETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:BETH
Last Name:STINNETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PETER PAN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6048
Mailing Address - Country:US
Mailing Address - Phone:405-292-3394
Mailing Address - Fax:405-364-7076
Practice Address - Street 1:900 N PORTER AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6426
Practice Address - Country:US
Practice Address - Phone:405-364-5222
Practice Address - Fax:405-364-7076
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100234860AMedicaid
OK100234860BMedicaid
OK100234860AMedicaid