Provider Demographics
NPI:1396528246
Name:SHAW, ALYSSA MARIE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MARIE
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JUDKINS DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03230-4144
Mailing Address - Country:US
Mailing Address - Phone:603-581-9150
Mailing Address - Fax:
Practice Address - Street 1:288 UNION AVE
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3115
Practice Address - Country:US
Practice Address - Phone:603-744-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0135080183500000X
NHPHCY-01498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist