Provider Demographics
NPI:1275133548
Name:HATFIELD, SHANE LANDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:LANDON
Last Name:HATFIELD
Suffix:
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 1:1235 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-8105
Mailing Address - Country:US
Mailing Address - Phone:660-641-0675
Mailing Address - Fax:
Practice Address - Street 1:3201 W BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2118
Practice Address - Country:US
Practice Address - Phone:660-826-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014026376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist