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NPI Code Detail

MEDICARE: AMANDA MAE SHAW PHARMD

MEDICARE:   AMANDA MAE SHAW  PHARMD
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
1183500000XPharmacist3329289OH

General Provider Information

NPI Number : 1659620144
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MAE SHAW PHARMD
Provider Business Mailing Address
First Line : 1853 DEER CROSSING DR
Second Line :
City : MARYSVILLE
State : OH
Zip : 43040-9381
Country : US
Telephone Number : 937-408-5330
Fax Number :
Provider Business Practice Location Address
First Line : 1280 DEMOREST RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43204-7003
Country : US
Telephone Number : 614-279-1962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2012
Last Update Date : 08/30/2012

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Directions to “ AMANDA MAE SHAW PHARMD” Practice Location

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