Provider Demographics
NPI:1972083392
Name:SHOEMAKER, OLIVIA BUNNER (PHARMD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:BUNNER
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:NICOLE
Other - Last Name:BUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1820
Practice Address - Country:US
Practice Address - Phone:304-285-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0011123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist