Provider Demographics
NPI:1508251810
Name:SHEEDY, DONNA JEAN (BS, RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:SHEEDY
Suffix:
Gender:F
Credentials:BS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 NW MILLER RD
Mailing Address - Street 2:APT E320
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4147
Mailing Address - Country:US
Mailing Address - Phone:207-632-9445
Mailing Address - Fax:
Practice Address - Street 1:1940 NW MILLER RD
Practice Address - Street 2:APT E320
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-4147
Practice Address - Country:US
Practice Address - Phone:207-632-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0014087183500000X
ME4232183500000X
MA19963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist