Provider Demographics
NPI:1508275140
Name:FARNSWORTH, SHAWNEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S 25TH E
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-5729
Mailing Address - Country:US
Mailing Address - Phone:208-522-2866
Mailing Address - Fax:208-522-2261
Practice Address - Street 1:1201 S 25TH E
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-5729
Practice Address - Country:US
Practice Address - Phone:208-522-2866
Practice Address - Fax:208-522-2261
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist