Provider Demographics
NPI:1013109701
Name:ABERNATHIE, SHAUN GORDON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:GORDON
Last Name:ABERNATHIE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 NE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1563
Mailing Address - Country:US
Mailing Address - Phone:541-957-2546
Mailing Address - Fax:541-957-2548
Practice Address - Street 1:1539 NE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1563
Practice Address - Country:US
Practice Address - Phone:541-957-2546
Practice Address - Fax:541-957-2548
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37634183500000X
ORRPH-0014717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS37634OtherFLORIDA STATE LICENSE NUMBER