Shadeland Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP482232 Issued in PA

Legal business name

SHADELAND PHARMACY LLC

Doing business as

Shadeland Pharmacy

Practice address

403 Shadeland Ave
Drexel Hill, PA 19026-1437

Phone

(610) 622-1630

Fax

(610) 622-1647

NPI assigned

Sep 13, 2011

Last updated

Dec 3, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mahen Patel

Title

Member

Phone

(267) 207-1114

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shadeland Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1093097206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 SHADELAND AVE",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261437",
            "telephone_number": "610-622-1630",
            "fax_number": "610-622-1647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 SHADELAND AVE",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261437",
            "telephone_number": "610-622-1630",
            "fax_number": "610-622-1647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADELAND PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MAHEN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "267-207-1114"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482232",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143594",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shadeland Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Anthony Sciortino, OD
• Grace Scorzetti, MS, OTR
• Alan Jeffrey Sears, MD
• Shaniya Selden
• Shadeland Pharmacy
• Ranjit R Shah, M.D.
• Joyce E Shappell, M.S.
• Talia Lynn Sharkey
• Rohit Sharma
• Christopher Shaw

• Community/Retail Pharmacy in Drexel Hill, PA
• Providers in Drexel Hill, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.