MEDICARE: DAVID 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	14504	OK

General Provider Information

NPI Number	:	1932482528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A SHAW

Provider Business Mailing Address
First Line	:	185 E 33RD ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-4602
Country	:	US
Telephone Number	:	405-348-8328
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 E 33RD ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-4602
Country	:	US
Telephone Number	:	405-348-8328
Fax Number	:

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

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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Directions to “ DAVID A SHAW ” Practice Location

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