MEDICARE: PATRICIA A SHAW

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	PS25620	FL

General Provider Information

NPI Number	:	1548198286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A SHAW

Provider Business Mailing Address
First Line	:	2215 NW 32ND TER
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-2722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 NW 32ND TER
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-2722
Country	:	US
Telephone Number	:	954-439-3864
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ PATRICIA A SHAW ” Practice Location

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