Provider Demographics
NPI:1871585976
Name:SHIELDS, CARL E (RPH)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:E
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 CHURCH ST
Mailing Address - Street 2:PO BOX 354
Mailing Address - City:PETROLIA
Mailing Address - State:PA
Mailing Address - Zip Code:16050-0354
Mailing Address - Country:US
Mailing Address - Phone:724-756-4050
Mailing Address - Fax:724-756-4060
Practice Address - Street 1:296 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PETROLIA
Practice Address - State:PA
Practice Address - Zip Code:16050-0354
Practice Address - Country:US
Practice Address - Phone:724-756-4050
Practice Address - Fax:724-756-4060
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038470L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP038470LOtherPA STATE PHARMACY LICENSE