Provider Demographics
NPI:1396016440
Name:LIGHTNER, SHAWN (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:LIGHTNER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7826
Mailing Address - Country:US
Mailing Address - Phone:719-522-2201
Mailing Address - Fax:719-522-2204
Practice Address - Street 1:9225 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7826
Practice Address - Country:US
Practice Address - Phone:719-522-2201
Practice Address - Fax:719-522-2204
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist