Active NPI
Bradley Shaw, PHARMD
- Pharmacist
- Friendship, WI
National Provider Identifier
1649004128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15194-40
- Practice address
- PO Box 40
Friendship, WI 53934-0040 - Phone
- (608) 339-3331
- NPI assigned
- Aug 28, 2024
- Last updated
- Aug 28, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Compounded Sterile Preparations Pharmacist | 1835C0207X | 15194-40 | WI | |
| Pharmacist | 183500000X | 15194-40 | WI | Primary |
Addresses
Primary practice location
PO Box 40
Friendship, WI 53934-0040
Mailing address
PO Box 40
Friendship, WI 53934-0040
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15194-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724803200000",
"number": "1649004128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40",
"city": "FRIENDSHIP",
"state": "WI",
"postal_code": "539340040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PO BOX 40",
"city": "FRIENDSHIP",
"state": "WI",
"postal_code": "539340040",
"telephone_number": "608-339-3331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "BRADLEY",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-28",
"last_updated": "2024-08-28",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "1835C0207X",
"taxonomy_group": "",
"desc": "Pharmacist, Compounded Sterile Preparations",
"state": "WI",
"license": "15194-40",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "15194-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Friendship, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.