Provider Demographics
NPI:1841891082
Name:WARNER, SHAWN R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:R
Last Name:WARNER
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 1:16 ZOAR AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5745
Mailing Address - Country:US
Mailing Address - Phone:518-577-0295
Mailing Address - Fax:
Practice Address - Street 1:416 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3704
Practice Address - Country:US
Practice Address - Phone:331-022-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH83458183500000X
NY067304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist