Provider Demographics
NPI:1194243022
Name:SHIPMAN, DENVER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DENVER
Middle Name:
Last Name:SHIPMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75799-6600
Mailing Address - Country:US
Mailing Address - Phone:903-565-6539
Mailing Address - Fax:
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:166-513-6213
Practice Address - Fax:316-634-3066
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-168731835P1300X
TX617001835P1300X
HIPH40431835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric