Provider Demographics
NPI:1821399478
Name:SHEDECK, PATRICIA II
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SHEDECK
Suffix:II
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 1:6210 FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4027
Mailing Address - Country:US
Mailing Address - Phone:281-487-6170
Mailing Address - Fax:281-487-6778
Practice Address - Street 1:9828 BLACKHAWK BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2246
Practice Address - Country:US
Practice Address - Phone:713-991-3762
Practice Address - Fax:713-991-5419
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-1904183500000X
TX36273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist