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General NPI Number Information
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NPI Number | 1912504994
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Entity Type | Individual
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Provider Name | SHADE PIPER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2020
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 3050 S NATIONAL AVE STE 109
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4242
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Country | US
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Telephone | 417-881-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 26 CEDAR CREEK LN
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City | FAIR GROVE
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State | MO
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Zip | 65648-9171
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Country | US
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Telephone |
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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 | 2020030189
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License Number State | MO
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