Provider Demographics
NPI:1801372057
Name:MCGUIRE, SHAUNA LEE THOMASON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:LEE THOMASON
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2330
Mailing Address - Country:US
Mailing Address - Phone:618-351-0710
Mailing Address - Fax:
Practice Address - Street 1:915 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2330
Practice Address - Country:US
Practice Address - Phone:618-351-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist