Provider Demographics
NPI:1043814106
Name:DUDICH, SHANNON LEIGH (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:DUDICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SWISSVALE
Mailing Address - State:PA
Mailing Address - Zip Code:15218-2431
Mailing Address - Country:US
Mailing Address - Phone:412-271-6733
Mailing Address - Fax:
Practice Address - Street 1:7406 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SWISSVALE
Practice Address - State:PA
Practice Address - Zip Code:15218-2431
Practice Address - Country:US
Practice Address - Phone:412-271-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist