Provider Demographics
NPI:1053157495
Name:CRESS, SHAWNEE MIRRIA
Entity type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:MIRRIA
Last Name:CRESS
Suffix:
Gender:F
Credentials:
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 255
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:KY
Mailing Address - Zip Code:40823-0255
Mailing Address - Country:US
Mailing Address - Phone:606-671-0425
Mailing Address - Fax:
Practice Address - Street 1:1255 N 12TH ST STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1838
Practice Address - Country:US
Practice Address - Phone:606-248-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY024339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist