Provider Demographics
NPI:1396072872
Name:REYNOLDS SHAW, SONJA (PHARMD)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:REYNOLDS SHAW
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 1:1100 N HWY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-2616
Mailing Address - Country:US
Mailing Address - Phone:580-252-2375
Mailing Address - Fax:
Practice Address - Street 1:1100 N HWY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-2616
Practice Address - Country:US
Practice Address - Phone:580-252-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47245183500000X
OK14010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist