Provider Demographics
NPI:1811278724
Name:MCGEE, SHAWN BRADLEY
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:BRADLEY
Last Name:MCGEE
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 1:1415 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2269
Mailing Address - Country:US
Mailing Address - Phone:337-468-3666
Mailing Address - Fax:337-468-3289
Practice Address - Street 1:1415 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2269
Practice Address - Country:US
Practice Address - Phone:337-468-3666
Practice Address - Fax:337-468-3289
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist