Healthcare Provider Details

I. General information

NPI: 1336211135
Provider Name (Legal Business Name): SHADY MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 CENTRE AVE
PITTSBURGH PA
15213
US

IV. Provider business mailing address

5020 CENTRE AVE
PITTSBURGH PA
15213
US

V. Phone/Fax

Practice location:
  • Phone: 412-586-5410
  • Fax: 412-586-5351
Mailing address:
  • Phone: 412-586-5410
  • Fax: 412-586-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPP414789L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP414789L
License Number StatePA

VIII. Authorized Official

Name: MARVIN SHEFFLER
Title or Position: PRESIDENT
Credential:
Phone: 412-417-9861