Provider Demographics
NPI:1225624000
Name:SHAW, TOMMY W (PD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:W
Last Name:SHAW
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6796
Mailing Address - Country:US
Mailing Address - Phone:501-745-2888
Mailing Address - Fax:
Practice Address - Street 1:1966 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6796
Practice Address - Country:US
Practice Address - Phone:501-745-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPDO1693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist