Provider Demographics
NPI:1104426345
Name:FOREHAND, SHANNON WAYNE (RPH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:WAYNE
Last Name:FOREHAND
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 1:2765 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3740
Mailing Address - Country:US
Mailing Address - Phone:254-968-0660
Mailing Address - Fax:254-968-7012
Practice Address - Street 1:2765 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3740
Practice Address - Country:US
Practice Address - Phone:254-968-0660
Practice Address - Fax:254-968-7012
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist