Provider Demographics
NPI:1851686307
Name:NORDEEN, SHANNA LEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEE
Last Name:NORDEEN
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 1:15150 CEDAR AVE
Mailing Address - Street 2:T0643
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7056
Mailing Address - Country:US
Mailing Address - Phone:952-891-5515
Mailing Address - Fax:952-891-5516
Practice Address - Street 1:15150 CEDAR AVE
Practice Address - Street 2:T0643
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7056
Practice Address - Country:US
Practice Address - Phone:952-891-5515
Practice Address - Fax:952-891-5516
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist