Provider Demographics
NPI:1326640673
Name:GUTHRIE, SHAWN THOMAS
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:THOMAS
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 JETT LN
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-5544
Mailing Address - Country:US
Mailing Address - Phone:304-636-3728
Mailing Address - Fax:
Practice Address - Street 1:40 JETT LN
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-5544
Practice Address - Country:US
Practice Address - Phone:304-636-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist