Provider Demographics
NPI:1457638488
Name:SHOCKLEY, ROBBIE DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:DEAN
Last Name:SHOCKLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FREIDA LN
Mailing Address - Street 2:
Mailing Address - City:CLEVER
Mailing Address - State:MO
Mailing Address - Zip Code:65631-6731
Mailing Address - Country:US
Mailing Address - Phone:417-369-0600
Mailing Address - Fax:
Practice Address - Street 1:1675 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-5152
Practice Address - Country:US
Practice Address - Phone:417-485-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044787183500000X
TX39738183500000X
NMRP00006467183500000X
IA16641183500000X
KS1-12695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist