Provider Demographics
NPI:1417286246
Name:SHEA, CHARLES ALEXANDER III (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALEXANDER
Last Name:SHEA
Suffix:III
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 1:4005 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-3406
Mailing Address - Country:US
Mailing Address - Phone:215-943-2221
Mailing Address - Fax:215-943-2202
Practice Address - Street 1:4005 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-3406
Practice Address - Country:US
Practice Address - Phone:215-943-2221
Practice Address - Fax:215-943-2202
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043375L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist