Provider Demographics
NPI:1346536091
Name:SHORT, MEGAN D (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:D
Last Name:SHORT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 E 120TH AVE
Mailing Address - Street 2:STORE 1372
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-5711
Mailing Address - Country:US
Mailing Address - Phone:303-280-6273
Mailing Address - Fax:303-280-6273
Practice Address - Street 1:1001 E 120TH AVE
Practice Address - Street 2:STORE 1372
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-5711
Practice Address - Country:US
Practice Address - Phone:303-280-6273
Practice Address - Fax:303-280-6273
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO17387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist