Provider Demographics
NPI:1679856108
Name:LAROSSA-SHEEHAN, MICHELE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:LAROSSA-SHEEHAN
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 1:185 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5522
Mailing Address - Country:US
Mailing Address - Phone:781-321-1765
Mailing Address - Fax:781-397-0017
Practice Address - Street 1:185 CENTRE ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5522
Practice Address - Country:US
Practice Address - Phone:781-321-1765
Practice Address - Fax:781-397-0017
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist