MEDICARE: JONATHON 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	19810	AL

General Provider Information

NPI Number	:	1619579471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHON SHAW

Provider Business Mailing Address
First Line	:	1090 MILITARY ST S
Second Line	:
City	:	HAMILTON
State	:	AL
Zip	:	35570-5036
Country	:	US
Telephone Number	:	205-412-9742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 MILITARY ST S
Second Line	:
City	:	HAMILTON
State	:	AL
Zip	:	35570-5006
Country	:	US
Telephone Number	:	205-921-7465
Fax Number	:

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

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “ JONATHON SHAW ” Practice Location

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