Provider Demographics
NPI:1558572669
Name:FAGAN, SHELLY ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:ELIZABETH
Last Name:FAGAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 COSMIC WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415
Mailing Address - Country:US
Mailing Address - Phone:814-323-5695
Mailing Address - Fax:
Practice Address - Street 1:1527 SASSAFRAS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1859
Practice Address - Country:US
Practice Address - Phone:814-877-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist