Provider Demographics
NPI:1669628863
Name:TANKERSLEY, SHAWN DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DAVID
Last Name:TANKERSLEY
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 1:1732 HIGHWAY 192 W
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1675
Mailing Address - Country:US
Mailing Address - Phone:606-878-1568
Mailing Address - Fax:606-878-1851
Practice Address - Street 1:1732 HIGHWAY 192 W
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1675
Practice Address - Country:US
Practice Address - Phone:606-878-1568
Practice Address - Fax:606-878-1851
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013381183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist