Provider Demographics
NPI:1396968855
Name:JOHN, SHINEY MATHEW (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHINEY
Middle Name:MATHEW
Last Name:JOHN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MORGAN LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2224
Mailing Address - Country:US
Mailing Address - Phone:610-565-7965
Mailing Address - Fax:
Practice Address - Street 1:512 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-1014
Practice Address - Country:US
Practice Address - Phone:484-953-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043165L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist