Provider Demographics
NPI:1053605121
Name:SHEAHAN, JAMES FRANCIS JR
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FRANCIS
Last Name:SHEAHAN
Suffix:JR
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 1:3535 TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5334
Mailing Address - Country:US
Mailing Address - Phone:715-392-9876
Mailing Address - Fax:715-392-9876
Practice Address - Street 1:3535 TOWER AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5334
Practice Address - Country:US
Practice Address - Phone:715-392-9876
Practice Address - Fax:715-392-9876
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist