Provider Demographics
NPI:1700469533
Name:ARCHER, SHANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:ARCHER
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 1:10421 BALLENTINE ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-3046
Mailing Address - Country:US
Mailing Address - Phone:618-267-1634
Mailing Address - Fax:
Practice Address - Street 1:10421 BALLENTINE ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-3046
Practice Address - Country:US
Practice Address - Phone:618-267-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-17079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist