Provider Demographics
NPI:1033416649
Name:HERRIFORD, SHAWNA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MARIE
Last Name:HERRIFORD
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 1:151 NE HAMPE WAY
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2403
Mailing Address - Country:US
Mailing Address - Phone:360-748-3049
Mailing Address - Fax:
Practice Address - Street 1:151 NE HAMPE WAY
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2403
Practice Address - Country:US
Practice Address - Phone:360-748-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60153687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist