Provider Demographics
NPI:1033718481
Name:SHENAZ, SHENAZ
Entity Type:Individual
Prefix:
First Name:SHENAZ
Middle Name:
Last Name:SHENAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 REILY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-2551
Mailing Address - Country:US
Mailing Address - Phone:917-306-9584
Mailing Address - Fax:
Practice Address - Street 1:5 FRIENDLY DR
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-8700
Practice Address - Country:US
Practice Address - Phone:717-834-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist