Provider Demographics
NPI:1942096763
Name:CLUGSTON, SHANE EDWIN
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:EDWIN
Last Name:CLUGSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N ANTRIM WAY
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1403
Mailing Address - Country:US
Mailing Address - Phone:717-597-2426
Mailing Address - Fax:717-597-3705
Practice Address - Street 1:145 N ANTRIM WAY
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1403
Practice Address - Country:US
Practice Address - Phone:717-597-2426
Practice Address - Fax:717-597-3705
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043511L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist