Provider Demographics
NPI:1104032879
Name:SHINABERY, RANDY LEE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEE
Last Name:SHINABERY
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3259
Mailing Address - Country:US
Mailing Address - Phone:870-933-6369
Mailing Address - Fax:870-933-6378
Practice Address - Street 1:1432 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3259
Practice Address - Country:US
Practice Address - Phone:870-933-6369
Practice Address - Fax:870-933-6378
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist