Provider Demographics
NPI:1710273974
Name:VIERRA, SHAYNE LYNNE (RPH)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:LYNNE
Last Name:VIERRA
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 1:3900 SISK RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-3215
Mailing Address - Country:US
Mailing Address - Phone:209-545-3325
Mailing Address - Fax:209-545-3325
Practice Address - Street 1:3900 SISK RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-3215
Practice Address - Country:US
Practice Address - Phone:209-545-3325
Practice Address - Fax:209-545-3325
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist