Provider Demographics
NPI:1609304906
Name:SHEA, ROSEMARY (RPH)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2051
Mailing Address - Country:US
Mailing Address - Phone:860-620-9060
Mailing Address - Fax:860-620-1953
Practice Address - Street 1:505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2051
Practice Address - Country:US
Practice Address - Phone:860-620-9060
Practice Address - Fax:860-620-9060
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist