Provider Demographics
NPI:1407136047
Name:SHORE, DAVID R (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:SHORE
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 1:4395 KIMBALL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4409
Mailing Address - Country:US
Mailing Address - Phone:678-566-0422
Mailing Address - Fax:678-566-3112
Practice Address - Street 1:4395 KIMBALL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-4409
Practice Address - Country:US
Practice Address - Phone:678-566-0422
Practice Address - Fax:678-566-3112
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist