Provider Demographics
NPI:1134423528
Name:ANDRUS, SHAWN EVAN
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:EVAN
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CHESTERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-6019
Mailing Address - Country:US
Mailing Address - Phone:405-745-5004
Mailing Address - Fax:405-745-5004
Practice Address - Street 1:3500 CHESTERFIELD PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-6019
Practice Address - Country:US
Practice Address - Phone:405-745-5004
Practice Address - Fax:405-745-5004
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10547183500000X
TX27756183500000X
MO2010038516183500000X
NV17848183500000X
KS1-14985183500000X
VA0202210139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist