Provider Demographics
NPI:1629378773
Name:SAMEIRO, SHAWN (RPH, LAC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:SAMEIRO
Suffix:
Gender:M
Credentials:RPH, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 MINERAL WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4903
Mailing Address - Country:US
Mailing Address - Phone:731-642-4092
Mailing Address - Fax:
Practice Address - Street 1:1119 MINERAL WELLS AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4903
Practice Address - Country:US
Practice Address - Phone:731-642-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40773183500000X
AZS015073183500000X
AZ0928171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171100000XOther Service ProvidersAcupuncturist