Individual
ROBERTA L SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
2345 BENT WAY, LONGMONT, CO 80503-7614
(303) 678-3243
Mailing address
2345 BENT WAY, LONGMONT, CO 80503-7614
(303) 678-3243
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
15986
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013254
KAISER-COMMERCIAL NUMBER
—
Enumeration date
02/27/2007
Last updated
11/02/2007
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