Provider Demographics
NPI:1336424407
Name:SHAW, ALNITA K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ALNITA
Middle Name:K
Last Name:SHAW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5653 HILLSIDE LANDINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3242
Mailing Address - Country:US
Mailing Address - Phone:863-815-2982
Mailing Address - Fax:863-815-2982
Practice Address - Street 1:6730 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3284
Practice Address - Country:US
Practice Address - Phone:863-858-3829
Practice Address - Fax:863-815-9763
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist