Healthcare Provider Details

I. General information

NPI: 1144981267
Provider Name (Legal Business Name): DAVID MATTHEW SHORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 OHIO RIVER RD
WHEELERSBURG OH
45694-1625
US

IV. Provider business mailing address

PO BOX 881
FLATWOODS KY
41139-0881
US

V. Phone/Fax

Practice location:
  • Phone: 740-574-5054
  • Fax: 740-574-8924
Mailing address:
  • Phone: 606-547-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number060003174
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: