Healthcare Provider Details

I. General information

NPI: 1952872848
Provider Name (Legal Business Name): SHANE DONNELLY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DELAFIELD RD
PITTSBURGH PA
15215-1802
US

IV. Provider business mailing address

1010 DELAFIELD RD
PITTSBURGH PA
15215-1802
US

V. Phone/Fax

Practice location:
  • Phone: 724-991-1373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP449736
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449736
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: