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General NPI Number Information
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NPI Number | 1336211135
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Entity Type | Organization
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Legal Business Name | SHADY MED INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 5020 CENTRE AVE
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City | PITTSBURGH
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State | PA
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Zip | 15213
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Country | US
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Telephone | 412-586-5410
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Fax | 412-586-5351
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Provider Business Mailing Address
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Address Line | 5020 CENTRE AVE
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City | PITTSBURGH
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State | PA
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Zip | 15213
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Country | US
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Telephone | 412-586-5410
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Fax | 412-586-5351
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARVIN SHEFFLER
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Credential |
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Telephone | 412-417-9861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP414789L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PP414789L
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License Number State | PA
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