Provider Demographics
NPI:1710353461
Name:CHIWARA, SHINGAIRAI B
Entity Type:Individual
Prefix:
First Name:SHINGAIRAI
Middle Name:B
Last Name:CHIWARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 W DILL AVE
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-8291
Mailing Address - Country:US
Mailing Address - Phone:520-371-0215
Mailing Address - Fax:
Practice Address - Street 1:2785 N PINAL AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-7916
Practice Address - Country:US
Practice Address - Phone:520-421-0031
Practice Address - Fax:520-421-7166
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist