Provider Demographics
NPI:1154667079
Name:PUCKETT MAY, SHANNON DIANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:DIANNE
Last Name:PUCKETT MAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:DIANNE
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2713 STINSON PL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1344
Mailing Address - Country:US
Mailing Address - Phone:406-459-6559
Mailing Address - Fax:406-238-5870
Practice Address - Street 1:123 S 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4227
Practice Address - Country:US
Practice Address - Phone:406-247-3350
Practice Address - Fax:406-247-3389
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60292584183500000X
MT119211835P2201X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care