Provider Demographics
NPI:1407352917
Name:HIGHTOWER, SHELLEY VON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:VON
Last Name:HIGHTOWER
Suffix:
Gender:F
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 1:2111 E 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-8636
Mailing Address - Country:US
Mailing Address - Phone:813-867-8213
Mailing Address - Fax:813-867-8213
Practice Address - Street 1:5008 W. LINEBAUGH AVE, SUITE 35
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624
Practice Address - Country:US
Practice Address - Phone:813-867-8213
Practice Address - Fax:813-867-8213
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02054000183500000X
FLPS24978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist