Healthcare Provider Details

I. General information

NPI: 1376130997
Provider Name (Legal Business Name): DAVID REED SHAKESPEARE PHARM-D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 W CENTER ST
KANAB UT
84741-3416
US

IV. Provider business mailing address

176 W CENTER ST
KANAB UT
84741-3416
US

V. Phone/Fax

Practice location:
  • Phone: 356-442-4184
  • Fax: 435-644-2057
Mailing address:
  • Phone: 356-442-4184
  • Fax: 435-644-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4817479
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: