Provider Demographics
NPI:1205435252
Name:SHAW, CASSIE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:MARIE
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 1:78MDG
Mailing Address - Street 2:655 SEVENTH STREET
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098
Mailing Address - Country:US
Mailing Address - Phone:478-327-8487
Mailing Address - Fax:
Practice Address - Street 1:78MDG
Practice Address - Street 2:655 SEVENTH STREET
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098
Practice Address - Country:US
Practice Address - Phone:478-327-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist