MEDICARE: LEAH SHAW PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS49179	FL
2	183500000X	Pharmacist	PU7162	FL
3	183500000X	Pharmacist	PR12595	ME

General Provider Information

NPI Number	:	1174937585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH SHAW PHARMD

Provider Business Mailing Address
First Line	:	4175 S PIPKIN RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1699
Country	:	US
Telephone Number	:	866-577-1440
Fax Number	:	866-577-1444

Provider Business Practice Location Address
First Line	:	4175 S PIPKIN RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1699
Country	:	US
Telephone Number	:	866-577-1440
Fax Number	:	866-577-1444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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Directions to “ LEAH SHAW PHARMD” Practice Location

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