Provider Demographics
NPI:1588865430
Name:SHTIVELMAN, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:SHTIVELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 BALDWIN ST
Mailing Address - Street 2:APT 327
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-2272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 BALDWIN ST
Practice Address - Street 2:APT 327
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-2272
Practice Address - Country:US
Practice Address - Phone:412-725-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043215L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist