MEDICARE: DR. SHALESHANDA LIGHTBOURNE 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	PS41474	FL

General Provider Information

NPI Number	:	1316220957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHALESHANDA LIGHTBOURNE PHARM.D.

Provider Business Mailing Address
First Line	:	3490 BIRD AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4301
Country	:	US
Telephone Number	:	305-446-5037
Fax Number	:

Provider Business Practice Location Address
First Line	:	3490 BIRD AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4301
Country	:	US
Telephone Number	:	305-446-5037
Fax Number	:

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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Directions to “ DR. SHALESHANDA LIGHTBOURNE PHARM.D.” Practice Location

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