Active NPI
Shane C Walter
- Pharmacist
- Eatontown, NJ
National Provider Identifier
1568065050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI03884100
- Practice address
- 130 Highway 35
Eatontown, NJ 07724-1814 - Phone
- (732) 542-7333
- NPI assigned
- Nov 18, 2020
- Last updated
- Nov 18, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI03884100 | NJ | Primary |
Addresses
Primary practice location
130 Highway 35
Eatontown, NJ 07724-1814
Mailing address
15 Wilson Cir W
Red Bank, NJ 07701-5831
Phone (419) 953-1244
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03884100 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Jersey CVS Pharmacy LLC | Past | Accepting new patients | |
| New Jersey CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1568065050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 WILSON CIR W",
"city": "RED BANK",
"state": "NJ",
"postal_code": "077015831",
"telephone_number": "419-953-1244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 HIGHWAY 35",
"city": "EATONTOWN",
"state": "NJ",
"postal_code": "077241814",
"telephone_number": "732-542-7333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTER",
"first_name": "SHANE",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03884100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eatontown, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.