Provider Demographics
NPI:1316247802
Name:SHANGRAW, WILLIAM F (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:SHANGRAW
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6914
Mailing Address - Country:US
Mailing Address - Phone:480-644-8873
Mailing Address - Fax:480-644-9598
Practice Address - Street 1:1960 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6914
Practice Address - Country:US
Practice Address - Phone:480-644-8873
Practice Address - Fax:480-644-9598
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS009187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist