Provider Demographics
NPI:1972885804
Name:DAVIS, SHAWNDA KAY (DPH)
Entity type:Individual
Prefix:MRS
First Name:SHAWNDA
Middle Name:KAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E STATE HIGHWAY 152
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4402
Mailing Address - Country:US
Mailing Address - Phone:405-376-3751
Mailing Address - Fax:405-376-0854
Practice Address - Street 1:112 E STATE HIGHWAY 152
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4402
Practice Address - Country:US
Practice Address - Phone:405-376-3751
Practice Address - Fax:405-376-0854
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist