Healthcare Provider Details

I. General information

NPI: 1215520465
Provider Name (Legal Business Name): KAREN ANTOINETTE SHIVE PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

13588 NE 247TH LN
FORT MC COY FL
32134-4270
US

V. Phone/Fax

Practice location:
  • Phone: 352-283-5141
  • Fax:
Mailing address:
  • Phone: 352-283-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS25166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: