Provider Demographics
NPI:1841440260
Name:PATRICK, SHAWN GLENN (PHARM D)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:GLENN
Last Name:PATRICK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 MT HIGHWAY 359
Mailing Address - Street 2:
Mailing Address - City:CARDWELL
Mailing Address - State:MT
Mailing Address - Zip Code:59721-9704
Mailing Address - Country:US
Mailing Address - Phone:406-922-0843
Mailing Address - Fax:406-922-0885
Practice Address - Street 1:112 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3066
Practice Address - Country:US
Practice Address - Phone:406-922-0843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist