Provider Demographics
NPI:1316125388
Name:THE SHAW CORPORATION DBA SHAWS PHARMACY
Entity type:Organization
Organization Name:THE SHAW CORPORATION DBA SHAWS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CLEBURN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-235-0361
Mailing Address - Street 1:1633 E NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1374
Mailing Address - Country:US
Mailing Address - Phone:864-235-0361
Mailing Address - Fax:864-235-8384
Practice Address - Street 1:1633 E NORTH STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1374
Practice Address - Country:US
Practice Address - Phone:864-235-0361
Practice Address - Fax:864-235-8384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SHAW CORPORATION DBA SHAWS PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC271Medicaid
SC271Medicaid