Provider Demographics
NPI:1629387907
Name:SHANDERA, MISTY RAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:RAE
Last Name:SHANDERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-1819
Mailing Address - Country:US
Mailing Address - Phone:970-475-0192
Mailing Address - Fax:970-475-0315
Practice Address - Street 1:3700 W 10TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-1819
Practice Address - Country:US
Practice Address - Phone:970-475-0192
Practice Address - Fax:970-475-0315
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3365183500000X
CO18802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist