Provider Demographics
NPI:1316260151
Name:SHAY, ANDREW (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SHAY
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 71 BOX 148
Mailing Address - Street 2:
Mailing Address - City:ELLAMORE
Mailing Address - State:WV
Mailing Address - Zip Code:26267-9502
Mailing Address - Country:US
Mailing Address - Phone:304-472-0789
Mailing Address - Fax:
Practice Address - Street 1:731 BEVERLY PIKE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9729
Practice Address - Country:US
Practice Address - Phone:304-636-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist