Provider Demographics
NPI:1932936499
Name:MCDERMOTT, SHAINA RAE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SHAINA
Middle Name:RAE
Last Name:MCDERMOTT
Suffix:
Gender:F
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 1:512 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3727
Mailing Address - Country:US
Mailing Address - Phone:419-308-0735
Mailing Address - Fax:
Practice Address - Street 1:3404 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4467
Practice Address - Country:US
Practice Address - Phone:419-409-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist