Provider Demographics
NPI:1730689449
Name:SHAW, KATRINA (RPH)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6806 LIVORNO LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2283
Mailing Address - Country:US
Mailing Address - Phone:214-770-7735
Mailing Address - Fax:
Practice Address - Street 1:5101 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7762
Practice Address - Country:US
Practice Address - Phone:469-744-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist