Provider Demographics
NPI:1528529690
Name:MATNEY, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MATNEY
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 1:6110 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6110 E 86TH ST
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:IN
Practice Address - Zip Code:46250-3507
Practice Address - Country:US
Practice Address - Phone:317-558-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019253A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist