Healthcare Provider Details

I. General information

NPI: 1750441663
Provider Name (Legal Business Name): SHAWNA NOTTINGHAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115C SECOND ST.
MONUMENT CO
80132
US

IV. Provider business mailing address

15855 HERRING RD
COLORADO SPRINGS CO
80908-2101
US

V. Phone/Fax

Practice location:
  • Phone: 719-481-2209
  • Fax:
Mailing address:
  • Phone: 719-494-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14400
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: