Provider Demographics
NPI:1336742238
Name:FITZPATRICK, SHANNA ANN
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:ANN
Last Name:FITZPATRICK
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 1:11 ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1042
Mailing Address - Country:US
Mailing Address - Phone:603-692-6751
Mailing Address - Fax:
Practice Address - Street 1:11 ANDREWS RD
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1042
Practice Address - Country:US
Practice Address - Phone:603-692-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5116183500000X
NY039334183500000X
NHPHCY00987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist