Provider Demographics
NPI:1568073567
Name:SHAW, RAYMOND J (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:SHAW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 US HIGHWAY 50 E
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-2248
Mailing Address - Country:US
Mailing Address - Phone:636-583-7896
Mailing Address - Fax:
Practice Address - Street 1:807 US HIGHWAY 50 E
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-2248
Practice Address - Country:US
Practice Address - Phone:636-583-7896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019028675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist