Individual
ANGELA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-4570
(580) 421-6283
Mailing address
1001 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-4570
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
6949
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6949
OK LICENSE
OK
Enumeration date
10/18/2006
Last updated
07/23/2007
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