Provider Demographics
NPI:1255331260
Name:SHANE, ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:
Last Name:SHANE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARROW LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7000
Mailing Address - Country:US
Mailing Address - Phone:845-425-3646
Mailing Address - Fax:845-425-3646
Practice Address - Street 1:1757 CENTRAL PARK AVE
Practice Address - Street 2:PATHMARK PHARMACY
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2828
Practice Address - Country:US
Practice Address - Phone:914-961-2355
Practice Address - Fax:914-779-4071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist