Provider Demographics
NPI:1396880795
Name:ROE, SHAWN CURTIS (PHARM D)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:CURTIS
Last Name:ROE
Suffix:
Gender:M
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 1:335 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9274
Mailing Address - Country:US
Mailing Address - Phone:319-665-4045
Mailing Address - Fax:
Practice Address - Street 1:1150 5TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2932
Practice Address - Country:US
Practice Address - Phone:319-354-6953
Practice Address - Fax:319-354-6050
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist