Provider Demographics
NPI:1275624215
Name:SHADID, JAMIE JILL (R PH, MBA)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:JILL
Last Name:SHADID
Suffix:
Gender:F
Credentials:R PH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N STONEWALL
Mailing Address - Street 2:#213
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73190-0001
Mailing Address - Country:US
Mailing Address - Phone:405-271-6878
Mailing Address - Fax:405-271-6430
Practice Address - Street 1:1110 N STONEWALL
Practice Address - Street 2:#213
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73190-0001
Practice Address - Country:US
Practice Address - Phone:405-271-6878
Practice Address - Fax:405-271-6430
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist