Provider Demographics
NPI:1184088288
Name:SHAW, DAVID QUENTIN JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:QUENTIN
Last Name:SHAW
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 E 9TH AVE
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3908
Mailing Address - Country:US
Mailing Address - Phone:303-320-2167
Mailing Address - Fax:303-320-2999
Practice Address - Street 1:4567 E 9TH AVE
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3908
Practice Address - Country:US
Practice Address - Phone:303-320-2167
Practice Address - Fax:303-320-2999
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.00204091835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPHA.0020409OtherCOLORADO PHARMACIST LICENSE