Provider Demographics
NPI:1699005801
Name:AVERY, SHAWN PAUL (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PAUL
Last Name:AVERY
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 1:682 W PIZZICATO LN
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-3775
Mailing Address - Country:US
Mailing Address - Phone:505-400-6372
Mailing Address - Fax:
Practice Address - Street 1:1900 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-3407
Practice Address - Country:US
Practice Address - Phone:520-323-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist