Healthcare Provider Details

I. General information

NPI: 1073842902
Provider Name (Legal Business Name): SHEA M BEAL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121ST GENERAL HOSPITAL UNIT 15244
APO AP
96205-0017
US

IV. Provider business mailing address

40 JAMSILDONG SONGPAGU GALLERIA PALACE A2608
SEOUL SONGPAGU
138 220
KR

V. Phone/Fax

Practice location:
  • Phone: 01182279177984
  • Fax:
Mailing address:
  • Phone: 01020564970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00068559
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: