Provider Demographics
NPI:1760974034
Name:CANTU, JAIME LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:CANTU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:SHIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:602 S GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-2202
Mailing Address - Country:US
Mailing Address - Phone:307-315-7571
Mailing Address - Fax:
Practice Address - Street 1:500 N 5TH ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1480
Practice Address - Country:US
Practice Address - Phone:605-745-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR-66391835P0018X
WY4002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist