MEDICARE: MR. SHANE EDWIN CLUGSTON

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	RP043511L	PA

General Provider Information

NPI Number	:	1942096763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHANE EDWIN CLUGSTON

Provider Business Mailing Address
First Line	:	145 N ANTRIM WAY
Second Line	:
City	:	GREENCASTLE
State	:	PA
Zip	:	17225-1403
Country	:	US
Telephone Number	:	717-597-2426
Fax Number	:	717-597-3705

Provider Business Practice Location Address
First Line	:	145 N ANTRIM WAY
Second Line	:
City	:	GREENCASTLE
State	:	PA
Zip	:	17225-1403
Country	:	US
Telephone Number	:	717-597-2426
Fax Number	:	717-597-3705

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

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	04/17/2025

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Directions to “ MR. SHANE EDWIN CLUGSTON ” Practice Location

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