Provider Demographics
NPI:1841361839
Name:GREGORY, SHANA LEVINE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:LEVINE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 CHAMPIONS DR.
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707
Mailing Address - Country:US
Mailing Address - Phone:409-842-4445
Mailing Address - Fax:409-842-5259
Practice Address - Street 1:690 14TH ST.
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702
Practice Address - Country:US
Practice Address - Phone:409-842-4445
Practice Address - Fax:409-842-5259
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340891835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPERSON PHARMACY LICEOther34089