Provider Demographics
NPI:1235110461
Name:CLARAMBEAU, SHANE JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:JOSEPH
Last Name:CLARAMBEAU
Suffix:
Gender:M
Credentials:RPH
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 383
Mailing Address - Street 2:
Mailing Address - City:FORT PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57532-0383
Mailing Address - Country:US
Mailing Address - Phone:605-223-2166
Mailing Address - Fax:605-223-2166
Practice Address - Street 1:120 W SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2425
Practice Address - Country:US
Practice Address - Phone:605-224-7396
Practice Address - Fax:605-224-6037
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist