Provider Demographics
NPI:1467868612
Name:SHENEMAN, GALLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GALLEN
Middle Name:
Last Name:SHENEMAN
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 1:311 WEST 9TH STREET
Mailing Address - Street 2:PO BOX 758
Mailing Address - City:WELEETKA
Mailing Address - State:OK
Mailing Address - Zip Code:74880
Mailing Address - Country:US
Mailing Address - Phone:405-786-2246
Mailing Address - Fax:405-786-2409
Practice Address - Street 1:311 WEST 9TH STREET
Practice Address - Street 2:
Practice Address - City:WELEETKA
Practice Address - State:OK
Practice Address - Zip Code:74880
Practice Address - Country:US
Practice Address - Phone:405-786-2246
Practice Address - Fax:405-786-2409
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist