Provider Demographics
NPI:1619572690
Name:MCKEOWN, SHAUN PATRICK (RPH)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:PATRICK
Last Name:MCKEOWN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CHAMPIONS DR APT 903
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7257
Mailing Address - Country:US
Mailing Address - Phone:361-945-1783
Mailing Address - Fax:
Practice Address - Street 1:923 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3318
Practice Address - Country:US
Practice Address - Phone:936-634-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist