Provider Demographics
NPI:1689725673
Name:M SHAWN ANDERSON RPH PC
Entity Type:Organization
Organization Name:M SHAWN ANDERSON RPH PC
Other - Org Name:ANDERSON PHARMACY AND ACCENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MGR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:580-595-9500
Mailing Address - Street 1:5366 NW CACHE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3335
Mailing Address - Country:US
Mailing Address - Phone:580-595-9500
Mailing Address - Fax:580-585-6524
Practice Address - Street 1:5366 NW CACHE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3335
Practice Address - Country:US
Practice Address - Phone:580-595-9500
Practice Address - Fax:580-585-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
OK351773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100246120AMedicaid
2076300OtherPK
2076300OtherPK