MEDICARE: MR. ALLEN SHANE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	025077	NY

General Provider Information

NPI Number	:	1255331260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALLEN SHANE RPH

Provider Business Mailing Address
First Line	:	6 ARROW LN
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-7000
Country	:	US
Telephone Number	:	845-425-3646
Fax Number	:	845-425-3646

Provider Business Practice Location Address
First Line	:	1757 CENTRAL PARK AVE
Second Line	:	PATHMARK PHARMACY
City	:	YONKERS
State	:	NY
Zip	:	10710-2828
Country	:	US
Telephone Number	:	914-961-2355
Fax Number	:	914-779-4071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/08/2007

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