Provider Demographics
NPI:1255612578
Name:BIGELOW, SHA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHA
Middle Name:LYNN
Last Name:BIGELOW
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 1:1305 W CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4625
Mailing Address - Country:US
Mailing Address - Phone:918-485-6688
Mailing Address - Fax:918-485-6684
Practice Address - Street 1:1305 W CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4625
Practice Address - Country:US
Practice Address - Phone:918-485-6688
Practice Address - Fax:918-485-6684
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10736183500000X
OK13847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist