Individual
MRS. NICOLE LEVARSETTE SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1602 PRINCETON LN, AUGUSTA, GA 30904-5070
(706) 877-3194
Mailing address
1602 PRINCETON LN, AUGUSTA, GA 30904-5070
(706) 877-3194
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
470101090265145
GA
Other
Enumeration date
01/11/2010
Last updated
01/11/2010
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