Provider Demographics
NPI:1639700248
Name:PIPER, JOHN SHAWN (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SHAWN
Last Name:PIPER
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 1:105 E OVILLA RD
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2490
Mailing Address - Country:US
Mailing Address - Phone:972-617-8570
Mailing Address - Fax:972-617-8571
Practice Address - Street 1:105 E OVILLA RD
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2490
Practice Address - Country:US
Practice Address - Phone:972-617-8570
Practice Address - Fax:972-617-8571
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist