Provider Demographics
NPI:1568698850
Name:STONEROAD, SHANE D (RPH)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:D
Last Name:STONEROAD
Suffix:
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 1:10 NEWPORT PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8736
Mailing Address - Country:US
Mailing Address - Phone:717-567-6670
Mailing Address - Fax:
Practice Address - Street 1:10 NEWPORT PL
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-8736
Practice Address - Country:US
Practice Address - Phone:717-567-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044878L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist