MEDICARE: DR. CANDACE J. SHAW PHARM D

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	30694	CA

General Provider Information

NPI Number	:	1861476541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDACE J. SHAW PHARM D

Provider Business Mailing Address
First Line	:	1141 W REDONDO BEACH BLVD
Second Line	:	# 100
City	:	GARDENA
State	:	CA
Zip	:	90247-3586
Country	:	US
Telephone Number	:	310-515-1881
Fax Number	:	310-515-0951

Provider Business Practice Location Address
First Line	:	1141 W REDONDO BEACH BLVD
Second Line	:	# 100
City	:	GARDENA
State	:	CA
Zip	:	90247-3586
Country	:	US
Telephone Number	:	310-515-1881
Fax Number	:	310-515-0951

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/08/2007

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