Provider Demographics
NPI:1649564907
Name:SHAUGHNESSY, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BOSTON POST RD E
Mailing Address - Street 2:T-2570
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3702
Mailing Address - Country:US
Mailing Address - Phone:508-251-6958
Mailing Address - Fax:508-251-6968
Practice Address - Street 1:605 BOSTON POST RD E
Practice Address - Street 2:T-2570
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3702
Practice Address - Country:US
Practice Address - Phone:508-251-6958
Practice Address - Fax:508-251-6968
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist