Provider Demographics
NPI:1598037590
Name:SHEA, LAUREL R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:R
Last Name:SHEA
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 1:132 S ANITA DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3317
Mailing Address - Country:US
Mailing Address - Phone:877-778-3773
Mailing Address - Fax:800-951-7948
Practice Address - Street 1:132 S ANITA DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3317
Practice Address - Country:US
Practice Address - Phone:877-778-3773
Practice Address - Fax:800-951-7948
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist