Provider Demographics
NPI:1164288890
Name:SHEN, NATHAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 CHARWOOD RD STE C
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3125
Mailing Address - Country:US
Mailing Address - Phone:443-557-0100
Mailing Address - Fax:
Practice Address - Street 1:7805 HOUSE OF CORRECTION ROAD
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20764
Practice Address - Country:US
Practice Address - Phone:410-799-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist