Healthcare Provider Details

I. General information

NPI: 1689767725
Provider Name (Legal Business Name): ANTHONY WAYNE SHURTS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 BOLETUS CREEK DR
BAYFIELD CO
81122-9733
US

IV. Provider business mailing address

367 BOLETUS CREEK DR
BAYFIELD CO
81122-9733
US

V. Phone/Fax

Practice location:
  • Phone: 970-769-0117
  • Fax:
Mailing address:
  • Phone: 970-884-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-11205
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-15463
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: