Provider Demographics
NPI:1760087308
Name:SHENDY, KARTER A
Entity Type:Individual
Prefix:
First Name:KARTER
Middle Name:A
Last Name:SHENDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 WALKER ST APT 34
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2539
Mailing Address - Country:US
Mailing Address - Phone:978-888-3296
Mailing Address - Fax:
Practice Address - Street 1:516 MAIN ST # 522
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3880
Practice Address - Country:US
Practice Address - Phone:781-665-7107
Practice Address - Fax:781-662-9357
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist