Provider Demographics
NPI:1669772174
Name:SHEA, SANDY (PHARMD)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 HAMNER AVE
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3121
Mailing Address - Country:US
Mailing Address - Phone:951-360-1911
Mailing Address - Fax:951-360-1940
Practice Address - Street 1:6170 HAMNER AVE
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-3121
Practice Address - Country:US
Practice Address - Phone:951-360-1911
Practice Address - Fax:951-360-1940
Is Sole Proprietor?:No
Enumeration Date:2010-10-31
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist