Individual
MRS. SHAWN DANELLE RAYBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1310 S CONSTITUTION AVE, BROOKSHIRES PHARMACY 062, ASHDOWN, AR 71822
(903) 276-5260
(870) 898-5594
Mailing address
7125 FM 559, TEXARKANA, TX 75503
(903) 276-5260
(870) 898-5594
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD08930
AR
183500000X
Pharmacist
TX31189
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PD08930
STATE LICENSE
AR
01
—
TX31189
STATE LICENSE
TX
Enumeration date
06/09/2015
Last updated
06/09/2015
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