Provider Demographics
NPI:1174937585
Name:SHAW, LEAH (PHARMD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 S PIPKIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1699
Mailing Address - Country:US
Mailing Address - Phone:866-577-1440
Mailing Address - Fax:866-577-1444
Practice Address - Street 1:4175 S PIPKIN RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1699
Practice Address - Country:US
Practice Address - Phone:866-577-1440
Practice Address - Fax:866-577-1444
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49179183500000X
FLPU7162183500000X
MEPR12595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist