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General NPI Number Information
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NPI Number | 1831235746
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Entity Type | Individual
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Provider Name | JOHN LEROY SHAW RPH
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 37 HARRISVILLE ROAD
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City | OGDEN
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State | UT
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Zip | 84404
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Country | US
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Telephone | 801-621-2532
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Fax |
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Provider Business Mailing Address
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Address Line | 4589 W. 1650 NORTH
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City | PLAIN CITY
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State | UT
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Zip | 84404
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Country | US
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Telephone | 801-731-7674
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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 | 294489-1701
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License Number State | UT
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