Provider Demographics
NPI:1134628639
Name:SHINAL, ANN MARIE THERESA (CPHT)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:THERESA
Last Name:SHINAL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1325
Mailing Address - Country:US
Mailing Address - Phone:570-762-2668
Mailing Address - Fax:
Practice Address - Street 1:76 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1325
Practice Address - Country:US
Practice Address - Phone:570-762-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
590107010282604183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty