MEDICARE: MR. DAVID R. SHORE RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH014847	GA

General Provider Information

NPI Number	:	1407136047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID R. SHORE RPH.

Provider Business Mailing Address
First Line	:	4395 KIMBALL BRIDGE RD
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30022-4409
Country	:	US
Telephone Number	:	678-566-0422
Fax Number	:	678-566-3112

Provider Business Practice Location Address
First Line	:	4395 KIMBALL BRIDGE RD
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30022-4409
Country	:	US
Telephone Number	:	678-566-0422
Fax Number	:	678-566-3112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	12/21/2022

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