Provider Demographics
NPI:1194005785
Name:RICE, SHAWN (RPH)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:RICE
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 1:4029 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-1175
Mailing Address - Country:US
Mailing Address - Phone:352-628-3898
Mailing Address - Fax:352-628-9399
Practice Address - Street 1:4029 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-1175
Practice Address - Country:US
Practice Address - Phone:352-628-3898
Practice Address - Fax:352-628-9399
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist