Provider Demographics
NPI:1922387463
Name:DEPCINSKI, SHAWN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:DEPCINSKI
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 1:19251 MACK AVE STE 333
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2898
Mailing Address - Country:US
Mailing Address - Phone:313-343-7280
Mailing Address - Fax:313-343-7277
Practice Address - Street 1:19251 MACK AVE STE 333
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2898
Practice Address - Country:US
Practice Address - Phone:313-343-7280
Practice Address - Fax:313-343-7277
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020379301835P0018X
PARP4478931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist