Provider Demographics
NPI:1174966121
Name:BARKER, SHANNON ROSE (RPH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:BARKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1721
Mailing Address - Country:US
Mailing Address - Phone:970-484-1410
Mailing Address - Fax:970-484-3083
Practice Address - Street 1:2325 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1721
Practice Address - Country:US
Practice Address - Phone:970-484-1410
Practice Address - Fax:970-484-3083
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist