Provider Demographics
NPI:1699042812
Name:SHAW, HILLARY ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:ANN
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PLACHY DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2042
Mailing Address - Country:US
Mailing Address - Phone:319-610-0792
Mailing Address - Fax:
Practice Address - Street 1:165 COUNTRY CENTER DR
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8935
Practice Address - Country:US
Practice Address - Phone:970-731-6006
Practice Address - Fax:970-730-6015
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist