MEDICARE: SHANNON SUNDITA PHARMD

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	18078	CO

General Provider Information

NPI Number	:	1427207224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON SUNDITA PHARMD

Provider Business Mailing Address
First Line	:	200 QUEBEC ST BLDG 400
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80230-7145
Country	:	US
Telephone Number	:	303-340-4459
Fax Number	:	303-340-8078

Provider Business Practice Location Address
First Line	:	200 QUEBEC ST BLDG 400
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80230-7145
Country	:	US
Telephone Number	:	303-340-4459
Fax Number	:	303-340-8078

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

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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