Provider Demographics
NPI:1982231601
Name:BYRNES, SHANNON RENEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:RENEE
Last Name:BYRNES
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 1:357 LOWER RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-7694
Mailing Address - Country:US
Mailing Address - Phone:912-308-0866
Mailing Address - Fax:
Practice Address - Street 1:575 RIVERGATE LANE
Practice Address - Street 2:SUITE 111
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-375-7711
Practice Address - Fax:970-375-7722
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist