Provider Demographics
NPI:1316298565
Name:SHAIN, ERIC L (CPHT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:SHAIN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CORAL RIDGE DR # 365
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5433
Mailing Address - Country:US
Mailing Address - Phone:610-466-9533
Mailing Address - Fax:610-466-7604
Practice Address - Street 1:1440 CORAL RIDGE DR # 365
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5433
Practice Address - Country:US
Practice Address - Phone:610-466-9533
Practice Address - Fax:610-466-7604
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT 39580183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician