Provider Demographics
NPI:1154612927
Name:SABOL, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:SABOL
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 1:26 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16438-1441
Mailing Address - Country:US
Mailing Address - Phone:814-572-8163
Mailing Address - Fax:
Practice Address - Street 1:1 E HIGH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-1055
Practice Address - Country:US
Practice Address - Phone:814-438-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042637L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist