Provider Demographics
NPI:1124574496
Name:SHENEMAN, KRISTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SHENEMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WELEETKA
Mailing Address - State:OK
Mailing Address - Zip Code:74880
Mailing Address - Country:US
Mailing Address - Phone:405-786-2247
Mailing Address - Fax:405-786-2409
Practice Address - Street 1:309 W. 9TH STREET
Practice Address - Street 2:
Practice Address - City:WELEETKA
Practice Address - State:OK
Practice Address - Zip Code:74880
Practice Address - Country:US
Practice Address - Phone:405-786-2247
Practice Address - Fax:405-786-2409
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist