Provider Demographics
NPI:1932548211
Name:ATKINS, SHAWN (RPH)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:ATKINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 E WILSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3403
Mailing Address - Country:US
Mailing Address - Phone:801-913-8144
Mailing Address - Fax:
Practice Address - Street 1:847 E WILSHIRE PL
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-3403
Practice Address - Country:US
Practice Address - Phone:801-913-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2635091701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2635091701OtherUT LICENSE