Provider Demographics
NPI:1962033787
Name:FINK, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FINK
Suffix:
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 1:4001 HAMILTON CLEVES RD
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-9394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 HAMILTON CLEVES RD
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-9394
Practice Address - Country:US
Practice Address - Phone:513-353-0860
Practice Address - Fax:513-353-0835
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0132551835P0018X
IN26022240A1835P0018X
OH031224801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist