Provider Demographics
NPI:1780741355
Name:SHILEY, LU ANN M (CPHT)
Entity type:Individual
Prefix:MRS
First Name:LU ANN
Middle Name:M
Last Name:SHILEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:PA
Mailing Address - Zip Code:15954
Mailing Address - Country:US
Mailing Address - Phone:814-446-1141
Mailing Address - Fax:
Practice Address - Street 1:6858 ROUTE 711
Practice Address - Street 2:SUITE 3
Practice Address - City:SEWARD
Practice Address - State:PA
Practice Address - Zip Code:15954
Practice Address - Country:US
Practice Address - Phone:814-446-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA380101061157798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist