Provider Demographics
NPI:1497283113
Name:SHINE, LESTER RAY (RPH)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:RAY
Last Name:SHINE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 E 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4436
Mailing Address - Country:US
Mailing Address - Phone:303-255-0587
Mailing Address - Fax:303-255-0435
Practice Address - Street 1:3840 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4436
Practice Address - Country:US
Practice Address - Phone:303-255-0587
Practice Address - Fax:303-255-0435
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist