Provider Demographics
NPI:1093861577
Name:SHIECHEL, PAUL J (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SHIECHEL
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 E BASELINE RD APT 1072
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4723
Mailing Address - Country:US
Mailing Address - Phone:480-236-5018
Mailing Address - Fax:
Practice Address - Street 1:3132 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4502
Practice Address - Country:US
Practice Address - Phone:602-957-4265
Practice Address - Fax:602-954-7412
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist