Provider Demographics
NPI:1962629709
Name:SHAWNEE REGIONAL HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:SHAWNEE REGIONAL HOSPITAL PHARMACY
Other - Org Name:COMMUNITY HEALTH PARTNERS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-878-3435
Mailing Address - Street 1:1102 W MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1743
Mailing Address - Country:US
Mailing Address - Phone:405-878-3435
Mailing Address - Fax:405-878-3497
Practice Address - Street 1:1102 W MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1743
Practice Address - Country:US
Practice Address - Phone:405-878-3435
Practice Address - Fax:405-878-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10-4963333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy