Provider Demographics
NPI:1013109701
Name:ABERNATHIE, SHAUN GORDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:GORDON
Last Name:ABERNATHIE
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 1:6435 HAZELTINE NATIONAL DR STE 140
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5156
Mailing Address - Country:US
Mailing Address - Phone:855-274-1694
Mailing Address - Fax:
Practice Address - Street 1:6435 HAZELTINE NATIONAL DR STE 140
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5156
Practice Address - Country:US
Practice Address - Phone:855-274-1694
Practice Address - Fax:407-915-4422
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS37634OtherFLORIDA STATE LICENSE NUMBER