MEDICARE: SANDY SHEA PHARM.D.

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	61833	CA

General Provider Information

NPI Number	:	1669772174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY SHEA PHARM.D.

Provider Business Mailing Address
First Line	:	6170 HAMNER AVE
Second Line	:
City	:	MIRA LOMA
State	:	CA
Zip	:	91752-3121
Country	:	US
Telephone Number	:	951-360-1911
Fax Number	:	951-360-1940

Provider Business Practice Location Address
First Line	:	6170 HAMNER AVE
Second Line	:
City	:	MIRA LOMA
State	:	CA
Zip	:	91752-3121
Country	:	US
Telephone Number	:	951-360-1911
Fax Number	:	951-360-1940

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

Provider Enumeration Date	:	10/31/2010
Last Update Date	:	03/17/2019

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Directions to “ SANDY SHEA PHARM.D.” Practice Location

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