Provider Demographics
NPI:1992910442
Name:SHIRK, DARRELL JAMES
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:JAMES
Last Name:SHIRK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 GREENES PT
Mailing Address - Street 2:
Mailing Address - City:GRAVOIS MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:65037-8024
Mailing Address - Country:US
Mailing Address - Phone:573-374-6882
Mailing Address - Fax:
Practice Address - Street 1:901 KIDWELL DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1784
Practice Address - Country:US
Practice Address - Phone:573-378-4661
Practice Address - Fax:573-378-5053
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003000273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist