Provider Demographics
NPI:1558966374
Name:HALLORAN, SHAYNA LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:LEE
Last Name:HALLORAN
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 1:339 SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4309
Mailing Address - Country:US
Mailing Address - Phone:781-289-6099
Mailing Address - Fax:
Practice Address - Street 1:339 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4309
Practice Address - Country:US
Practice Address - Phone:781-289-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist