Provider Demographics
NPI:1861774911
Name:SHABANI, ALI R (RPH)
Entity type:Individual
Prefix:MR
First Name:ALI
Middle Name:R
Last Name:SHABANI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 NW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1601
Mailing Address - Country:US
Mailing Address - Phone:405-227-7818
Mailing Address - Fax:405-216-9660
Practice Address - Street 1:1400 E 2ND ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5321
Practice Address - Country:US
Practice Address - Phone:405-216-9672
Practice Address - Fax:405-216-9660
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist