Provider Demographics
NPI:1942408307
Name:SHEA, CARLTON JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:JOHN
Last Name:SHEA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 SPRINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1547
Mailing Address - Country:US
Mailing Address - Phone:814-474-2558
Mailing Address - Fax:
Practice Address - Street 1:7215 SPRINGSIDE DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-1547
Practice Address - Country:US
Practice Address - Phone:814-474-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030823L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist