Provider Demographics
NPI:1265590731
Name:CASTILLO, SHANA LEA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:LEA
Last Name:CASTILLO
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 1:5143 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-5024
Mailing Address - Country:US
Mailing Address - Phone:402-558-0971
Mailing Address - Fax:
Practice Address - Street 1:7151 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2652
Practice Address - Country:US
Practice Address - Phone:402-558-8551
Practice Address - Fax:402-558-8770
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11718183500000X
AZ12826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist