Provider Demographics
NPI:1487894705
Name:SHAYKA, JARED M (PHARMD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:M
Last Name:SHAYKA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MOUNTAIN VIEW PLAZA
Mailing Address - Street 2:P.O. BOX 189
Mailing Address - City:CLIFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18413
Mailing Address - Country:US
Mailing Address - Phone:570-222-7500
Mailing Address - Fax:
Practice Address - Street 1:1866 STATE ROUTE 106
Practice Address - Street 2:SUITE 11
Practice Address - City:CLIFFORD
Practice Address - State:PA
Practice Address - Zip Code:18413
Practice Address - Country:US
Practice Address - Phone:570-222-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442680183500000X
MD18956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist