Provider Demographics
NPI:1710103650
Name:SCHUSTER, SHANE MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:MICHAEL
Last Name:SCHUSTER
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 1:2024 33RD ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1768
Mailing Address - Country:US
Mailing Address - Phone:712-490-7874
Mailing Address - Fax:712-255-8087
Practice Address - Street 1:3301 GORDON DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-3708
Practice Address - Country:US
Practice Address - Phone:712-234-1949
Practice Address - Fax:712-255-8087
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist