Active NPI
Gerard Joseph Shaw, R.PH.
- Pharmacist
- Southgate, MI
National Provider Identifier
1750911046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5315179356
- Practice address
- 11125 Allen Rd
Southgate, MI 48195-3331 - Phone
- (734) 287-4030
- Fax
- (734) 287-0266
- NPI assigned
- Jan 25, 2020
- Last updated
- Jan 25, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 5315179356 | MI | Primary |
Addresses
Primary practice location
11125 Allen Rd
Southgate, MI 48195-3331
Mailing address
11125 Allen Rd
Southgate, MI 48195-3331
Phone (734) 287-4030
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5315179356 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodward Detroit CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
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": "1579910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579910400000",
"number": "1750911046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11125 ALLEN RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481953331",
"telephone_number": "734-287-4030",
"fax_number": "734-287-0266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11125 ALLEN RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481953331",
"telephone_number": "734-287-4030",
"fax_number": "734-287-0266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "GERARD",
"middle_name": "JOSEPH",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-25",
"last_updated": "2020-01-25",
"certification_date": "2020-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5315179356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.