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General NPI Number Information
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NPI Number | 1467926360
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Entity Type | Individual
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Provider Name | PHILIP ALBERT MCSHANE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 12345 VIDALIA RD
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-8309
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Country | US
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Telephone | 228-255-7800
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Fax | 228-255-9999
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Provider Business Mailing Address
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Address Line | 12345 VIDALIA RD
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-8309
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Country | US
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Telephone | 228-255-7800
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Fax | 228-255-9999
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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 | T-09484
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License Number State | MS
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