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General NPI Number Information
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NPI Number | 1366040388
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Entity Type | Individual
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Provider Name | SHAWN JOSEPH
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Gender | Male
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 222 N CHICAGO AVE
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-1241
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Country | US
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Telephone | 414-501-1122
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Fax | 414-501-1125
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Provider Business Mailing Address
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Address Line | 1141 N OLD WORLD 3RD ST APT 906
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City | MILWAUKEE
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State | WI
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Zip | 53203-1123
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Country | US
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Telephone | 847-828-2026
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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 | 17338-40
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License Number State | WI
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