Provider Demographics
NPI:1316114085
Name:SHORE, MARTIN (RPH)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:SHORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:SHORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1155 S HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4019
Practice Address - Country:US
Practice Address - Phone:303-755-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist