Provider Demographics
NPI:1346570561
Name:SHIELDS, BRENT (RPH)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 S ALMA SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6905
Mailing Address - Country:US
Mailing Address - Phone:480-722-1780
Mailing Address - Fax:480-722-1872
Practice Address - Street 1:1975 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6905
Practice Address - Country:US
Practice Address - Phone:480-722-1780
Practice Address - Fax:480-722-1872
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist