NPI 1003911314

Glenn D Shaw, RPH

Practitioner Pharmacist Jackson, MS

Practice location

Address: 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116
Phone: (601) 364-1555

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence E-07155 (MS)

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Registry record

NPI: 1003911314
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Sep 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.