Provider Demographics
NPI:1982286852
Name:SORENSEN, SHAWN (PHARM D)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:SORENSEN
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:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634-0803
Mailing Address - Country:US
Mailing Address - Phone:435-851-9864
Mailing Address - Fax:
Practice Address - Street 1:520 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634-7702
Practice Address - Country:US
Practice Address - Phone:435-528-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5628274-17011835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care