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General NPI Number Information
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NPI Number | 1174906192
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Entity Type | Individual
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Provider Name | DALE SHAW PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 9390 N SCARLET CANYON DR
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City | TUCSON
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State | AZ
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Zip | 85743-5138
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Country | US
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Telephone | 503-957-9993
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Fax |
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Provider Business Mailing Address
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Address Line | 9390 N SCARLET CANYON DR
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City | TUCSON
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State | AZ
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Zip | 85743-5138
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Country | US
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Telephone | 503-957-9993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S021072
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0007589
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License Number State | OR
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