MEDICARE: ADAM OMAR SHANAH 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	S020384	AZ

General Provider Information

NPI Number	:	1750706602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM OMAR SHANAH RPH

Provider Business Mailing Address
First Line	:	600 N 4TH ST APT 521
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4134 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-4217
Country	:	US
Telephone Number	:	602-954-9119
Fax Number	:

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

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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Directions to “ ADAM OMAR SHANAH RPH” Practice Location

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