Provider Demographics
NPI:1669957700
Name:SHAW, ANNA MISHAEL (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MISHAEL
Last Name:SHAW
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:MISHAEL
Other - Last Name:BAYERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH, PHARMD
Mailing Address - Street 1:1308 BAYSHORE CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9140
Mailing Address - Country:US
Mailing Address - Phone:307-272-6597
Mailing Address - Fax:
Practice Address - Street 1:5353 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4178
Practice Address - Country:US
Practice Address - Phone:478-274-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist