Provider Demographics
NPI:1407118748
Name:SHAHEEN, E MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:MICHAEL
Last Name:SHAHEEN
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 1:1500 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1475
Mailing Address - Country:US
Mailing Address - Phone:740-392-5152
Mailing Address - Fax:740-392-1279
Practice Address - Street 1:1500 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1475
Practice Address - Country:US
Practice Address - Phone:740-392-5152
Practice Address - Fax:740-392-1279
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist