Provider Demographics
NPI:1184224222
Name:SAUNDERS, SHAYNE NATHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAYNE
Middle Name:NATHAN
Last Name:SAUNDERS
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 1:2289 FOX RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9785
Mailing Address - Country:US
Mailing Address - Phone:716-640-5922
Mailing Address - Fax:
Practice Address - Street 1:50 FOSTER BROOK BLVD
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3276
Practice Address - Country:US
Practice Address - Phone:814-368-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist