Individual provider Active NPI

Sandy Shea, PHARM.D.

  • Pharmacist
  • Mira Loma, CA
National Provider Identifier
1669772174
Registry record updated Mar 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
61833 Issued in CA
Practice address
6170 Hamner Ave
Mira Loma, CA 91752-3121
Phone
(951) 360-1911
Fax
(951) 360-1940
NPI assigned
Oct 31, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 61833 CA Primary

Addresses

Primary practice location

6170 Hamner Ave
Mira Loma, CA 91752-3121

Mailing address

6170 Hamner Ave
Mira Loma, CA 91752-3121
Phone (951) 360-1911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
61833CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1288483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552780800000",
    "number": "1669772174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6170 HAMNER AVE",
            "city": "MIRA LOMA",
            "state": "CA",
            "postal_code": "917523121",
            "telephone_number": "951-360-1911",
            "fax_number": "951-360-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6170 HAMNER AVE",
            "city": "MIRA LOMA",
            "state": "CA",
            "postal_code": "917523121",
            "telephone_number": "951-360-1911",
            "fax_number": "951-360-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "SANDY",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-31",
        "last_updated": "2019-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "61833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mira Loma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2019; 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.