MEDICARE: DR. SHELLEY VON HIGHTOWER PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI02054000	NJ
2	183500000X	Pharmacist	PS24978	FL

General Provider Information

NPI Number	:	1407352917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY VON HIGHTOWER PHARM D

Provider Business Mailing Address
First Line	:	2111 E 93RD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-8636
Country	:	US
Telephone Number	:	813-867-8213
Fax Number	:	813-867-8213

Provider Business Practice Location Address
First Line	:	5008 W. LINEBAUGH AVE, SUITE 35
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624
Country	:	US
Telephone Number	:	813-867-8213
Fax Number	:	813-867-8213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	02/26/2021

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