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NPI Code Detail

MEDICARE: DR. AN SHAO PHARMD

MEDICARE: DR. AN SHAO 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
1183500000XPharmacistRP451847PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RPOTHERPAPHARMACIST LICENSE

General Provider Information

NPI Number : 1952810921
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AN SHAO PHARMD
Provider Business Mailing Address
First Line : 134 N 52ND ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-2602
Country : US
Telephone Number : 347-820-0410
Fax Number :
Provider Business Practice Location Address
First Line : 1809 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-3119
Country : US
Telephone Number : 215-426-0956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2017
Last Update Date : 09/21/2017

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