Provider Demographics
NPI:1376726927
Name:SHAW, ROBERT A (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:SHAW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3220 WISCONSIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4047
Mailing Address - Country:US
Mailing Address - Phone:417-626-8180
Mailing Address - Fax:417-626-8176
Practice Address - Street 1:3220 WISCONSIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4047
Practice Address - Country:US
Practice Address - Phone:417-626-8180
Practice Address - Fax:417-626-8176
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-09230183500000X
MO028676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist