Provider Demographics
NPI:1780038810
Name:SHORT, SHANNON (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:SHORT
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-1225
Mailing Address - Country:US
Mailing Address - Phone:402-879-3281
Mailing Address - Fax:402-879-4924
Practice Address - Street 1:520 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1225
Practice Address - Country:US
Practice Address - Phone:402-879-3281
Practice Address - Fax:402-879-4924
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14085183500000X
KS1-15279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist