Provider Demographics
NPI:1023322138
Name:SHEAHAN, MICHAEL D (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SHEAHAN
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 1:1199 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2552
Mailing Address - Country:US
Mailing Address - Phone:732-494-0677
Mailing Address - Fax:732-452-0453
Practice Address - Street 1:1199 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2552
Practice Address - Country:US
Practice Address - Phone:732-494-0677
Practice Address - Fax:732-452-0453
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R102991200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist