Provider Demographics
NPI:1932500956
Name:BIRDSALL, SHAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BIRDSALL
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 1:14333 HWY 13 S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2153
Mailing Address - Country:US
Mailing Address - Phone:952-226-1442
Mailing Address - Fax:
Practice Address - Street 1:14333 HWY 13 S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2153
Practice Address - Country:US
Practice Address - Phone:952-226-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist