Provider Demographics
NPI:1578013728
Name:SEVY, SHEA
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:SEVY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:ID
Mailing Address - Zip Code:83850-0400
Mailing Address - Country:US
Mailing Address - Phone:208-682-3920
Mailing Address - Fax:208-682-3939
Practice Address - Street 1:504 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:ID
Practice Address - Zip Code:83850
Practice Address - Country:US
Practice Address - Phone:208-682-3920
Practice Address - Fax:208-682-3939
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist