Provider Demographics
NPI:1053539809
Name:SHEA, LYNN ANN (RPH, CDOE, CVDOE)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ANN
Last Name:SHEA
Suffix:
Gender:F
Credentials:RPH, CDOE, CVDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WEAVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-4616
Mailing Address - Country:US
Mailing Address - Phone:401-451-5574
Mailing Address - Fax:
Practice Address - Street 1:220 WEAVER HILL RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-4616
Practice Address - Country:US
Practice Address - Phone:401-451-5574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist