Provider Demographics
NPI:1376130997
Name:SHAKESPEARE, DAVID REED (PHARM-D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:REED
Last Name:SHAKESPEARE
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3416
Mailing Address - Country:US
Mailing Address - Phone:356-442-4184
Mailing Address - Fax:435-644-2057
Practice Address - Street 1:176 W CENTER ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3416
Practice Address - Country:US
Practice Address - Phone:356-442-4184
Practice Address - Fax:435-644-2057
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4817479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist