Brock Shawver, PHARMD
Individual provider Active NPI Pharmacist · American Falls, ID
NPI 1548035108 · NPPES record last updated Apr 3, 2024
Key facts
- NPI
- 1548035108
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P11040 (ID)
- Practice address
- 2827 Pocatello Ave
American Falls, ID 83211-5444 - Phone
- (208) 252-9805
- Fax
- (208) 252-9823
- NPI assigned
- Nov 22, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P11040 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ridley'S Family Markets, Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P11040 | ID | Yes |
Addresses
Primary practice location
2827 Pocatello Ave
American Falls, ID 83211-5444
Mailing address
2827 Pocatello Ave
American Falls, ID 83211-5444
Phone (208) 252-9805
Other providers in American Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.