Provider Demographics
NPI:1700062585
Name:SHEVLIN, DONNA WALASEK (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:WALASEK
Last Name:SHEVLIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LYNN
Other - Last Name:WALASEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-4090
Mailing Address - Country:US
Mailing Address - Phone:585-275-1028
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-4090
Practice Address - Country:US
Practice Address - Phone:585-275-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist