Provider Demographics
NPI:1417230012
Name:SHEN, JINNAN (RPH)
Entity Type:Individual
Prefix:
First Name:JINNAN
Middle Name:
Last Name:SHEN
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 1:1400 E BRADY ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1615
Mailing Address - Country:US
Mailing Address - Phone:414-272-2171
Mailing Address - Fax:
Practice Address - Street 1:1400 E BRADY ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1615
Practice Address - Country:US
Practice Address - Phone:414-272-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12557-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist