Provider Demographics
NPI:1467742296
Name:SHAY, JEAN S
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:S
Last Name:SHAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2607
Mailing Address - Country:US
Mailing Address - Phone:606-324-7149
Mailing Address - Fax:606-325-1929
Practice Address - Street 1:1203 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2607
Practice Address - Country:US
Practice Address - Phone:606-324-7149
Practice Address - Fax:606-325-1929
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist