Provider Demographics
NPI:1124653621
Name:SHAW, BRIAN AVERY (PHARMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:AVERY
Last Name:SHAW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 RICHMOND PLZ
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2564
Mailing Address - Country:US
Mailing Address - Phone:859-624-1093
Mailing Address - Fax:
Practice Address - Street 1:890 RICHMOND PLZ
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2564
Practice Address - Country:US
Practice Address - Phone:859-624-1093
Practice Address - Fax:859-625-9386
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0186191835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist