Provider Demographics
NPI:1861802399
Name:EARL, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:EARL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5415
Mailing Address - Country:US
Mailing Address - Phone:480-998-1670
Mailing Address - Fax:480-998-1812
Practice Address - Street 1:8165 E ROVEY AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5853
Practice Address - Country:US
Practice Address - Phone:616-890-4048
Practice Address - Fax:480-998-1812
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist