Provider Demographics
NPI:1063898955
Name:SHAY, PAUL (PHARMD, MBA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SHAY
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SHELBOURNE LN
Mailing Address - Street 2:APT 101
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-6360
Mailing Address - Country:US
Mailing Address - Phone:859-420-3093
Mailing Address - Fax:
Practice Address - Street 1:2532 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2019
Practice Address - Country:US
Practice Address - Phone:937-258-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist