Provider Demographics
NPI:1588767867
Name:SHENEMAN, GUY W (DR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:W
Last Name:SHENEMAN
Suffix:
Gender:M
Credentials:DR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:WELEETKA
Mailing Address - State:OK
Mailing Address - Zip Code:74880-0758
Mailing Address - Country:US
Mailing Address - Phone:405-786-2150
Mailing Address - Fax:
Practice Address - Street 1:311 WEST 9TH STREET
Practice Address - Street 2:
Practice Address - City:WELEETKA
Practice Address - State:OK
Practice Address - Zip Code:74880
Practice Address - Country:US
Practice Address - Phone:405-786-2246
Practice Address - Fax:405-786-2409
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist