Provider Demographics
NPI:1225357536
Name:SHANER, ANDREA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:SHANER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-3052
Mailing Address - Country:US
Mailing Address - Phone:724-547-5590
Mailing Address - Fax:724-542-8483
Practice Address - Street 1:ROUTE 819 BOX 1052
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-3052
Practice Address - Country:US
Practice Address - Phone:724-547-5590
Practice Address - Fax:724-542-8483
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP 043929R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist