Provider Demographics
NPI:1134413099
Name:SHAULL, KATHLEEN (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SHAULL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 W HIDDEN VIEW PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-4511
Mailing Address - Country:US
Mailing Address - Phone:520-237-1383
Mailing Address - Fax:
Practice Address - Street 1:10555 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9353
Practice Address - Country:US
Practice Address - Phone:520-219-4151
Practice Address - Fax:520-219-4151
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS006594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist